Feasibility Of Laparoscopic Distal Pancreatectomy Research Articles

Evaluation of factors predicting loss of benefit provided by laparoscopic distal pancreatectomy compared to open approach.

Several studies showed safety and feasibility of laparoscopic distal pancreatectomy (LDP) as compared to open distal pancreatectomy (ODP). Patients who underwent LDP or ODP (2015-2019) were included. A 1:1 propensity score matching (PSM) was used to reduce the effect of treatment selection bias. Aim of this study was to identify those factors influencing the loss of benefit (defined as a significantly better outcome compared to ODP) after LDP. Overall, 387 patients underwent DP (n = 250 LDP, n = 137 ODP). After PSM, 274 patients (n = 137 LDP, n = 137 ODP) were selected. LDP was associated with reduced intraoperative blood loss (median: 200mL vs. 250mL, p < 0.001), decreased wound infection rate (1% vs. 9%, p = 0.044) and shorter time to functional recovery (TFR) (median: 4days vs. 5days, p = 0.002). Consequently, TFR > 5days and blood loss > 250mL were defined as loss of benefit after LDP. In the LDP group, age > 70years [Odds Ratio (OR) 2.744, p = 0.022] and duration of surgery > 208min (OR 2.957, p = 0.019) were predictors of TFR > 5days and intraoperative blood loss > 250mL, respectively. No differences in terms of TFR were found between ODP and LDP groups in patients > 70years (p = 0.102). Intraoperative blood loss was significantly higher in the ODP group, also when the analysis was limited to surgical procedures with operative time > 208min (p = 0.003). In conclusion, LDP seems comparable to ODP in terms of TFR in patients aged > 70years. This finding could be helpful in the choice of the best surgical approach in elderly patients undergoing potentially challenging DPs.

Comparisons of Short-term and Long-term Outcomes Between Open and Laparoscopic Distal Pancreatectomy in Patients with Pancreatic Ductal Adenocarcinoma

Safety and feasibility of laparoscopic distal pancreatectomy (LDP) in regards to the pancreatic adenocarcinoma (PDAC) were not well-known. The present study aimed to compare the short-term and long-term outcomes of LDP with those of open distal pancreatectomy (ODP).

Feasibility of laparoscopic distal pancreatectomy for pancreatic solid tumors according to preoperative EUS-guided fine-needle aspiration biopsy

Feasibility of laparoscopic distal pancreatectomy for pancreatic solid tumors according to preoperative EUS-guided fine-needle aspiration biopsy

Laparoscopic distal pancreatectomy for solid-pseudopapillary tumor of the pancreas.

Solid-pseudopapillary tumor (SPT) of pancreas is a rare entity with a low malignant potential. We aimed to identify the safety and the feasibility of laparoscopic distal pancreatectomy for SPT. From May 2008 to August 2011, we performed 4 cases of laparoscopic, spleen-preserving, distal pancreatectomies for patients with SPT. We retrospectively collected the demographic characteristics, operative and postoperative details, and follow-up outcomes of the patients. Three female patients and 1 male patient with SPT underwent laparoscopic, spleen-preserving, distal pancreatectomy. The average operating time was 200 minutes. The average blood loss was 90 mL. The postoperative course of these patients was uneventful. All patients were followed-up and no local recurrence or metastasis was found. Laparoscopic distal pancreatectomy for patients with SPT is safe and feasible, with preferable operative outcomes, long-term tumor-free survival, and high spleen-preserving rate.

Effectiveness and feasibility of laparoscopic distal pancreatectomy on patients at high anesthetic risk.

Laparoscopic distal pancreatectomy (LDP) is the most acceptable procedure in laparoscopic pancreatic surgery. Nevertheless, knowledge regarding patients at a high anesthetic risk during lengthy and technically demanding LDP is controversial. This study aims to assess the feasibility and safety of LDP in patients with high anesthetic risk. We conducted a prospective collection retrospective review of patients underwent LDP and open distal pancreatectomy (ODP) from January 2011 until December 2013. By the American Society of Anesthesiologists score, patients were divided into low- and high-risk patients. We compared the clinical, perioperative, and postoperative results in these patients. The cohort included 77 patients: 20 underwent LDP, and 57 underwent ODP. There were 30 patients in the low-risk group and 47 patients in the high-risk group. In high-risk patients, LDP, compared with ODP, presented a shorter operating time (mean, 220.8±101.1 minutes versus 299.4±124.3 minutes; P=.038), less blood loss (409.3±569.9 mL versus 1083.1±1583.0 mL; P=.039), higher rate of spleen preservation (73.3% versus 43.8%, P=.037), and shorter length of postoperative hospital stay (LOS) (9.5±3.0 days versus 15.7±9.4 days; P=.044). In conclusion, LDP provides early recovery and better cosmetic appearance. In high anesthetic risk patients, LDP shows less operative time, less perioperative blood loss, a higher rate of spleen preservation, slighter complication, and shorter LOS, which might explain why LDP is a feasible and effective procedure.

Meta‐analysis of laparoscopic versus open distal pancreatectomy for pancreatic diseases

AimIncreasing studies have reported on the feasibility of laparoscopic distal pancreatectomy (LDP) versus open distal pancreatectomy (ODP) for pancreatic diseases; however, the therapeutic efficacies between the two procedures remain controversial. The aim of the present study was to conduct a meta‐analysis to evaluate the efficacy and safety of LDP for pancreatic diseases.Patients and MethodsSearches of the Medline, Embase, Cochrane Library, Chinese Biomedical Database, and CNKI were performed to identify relevant studies published between January 2001 and December 2011.ResultsSixteen studies involving 1796 participants were included. LDP was associated with longer operative time [mean difference (MD): −13.45, 95 per cent confidence interval (95 per cent CI): 8.18–18.17, P &lt; 0.00001] and fewer lymph nodes harvested (MD:−6.05, 95 per cent CI: −6.54 to −5.56, P &lt; 0.00001), but higher spleen preservation rates [odds ratio (OR): 3.38, 95 per cent CI: 1.93–5.9, P &lt; 0.00001], less estimated blood loss (MD: −389.75, 95 per cent CI: −407.96 to −371.55, P &lt; 0.00001), shorter hospital stay (MD: −3.95, 95 per cent CI: −4.0 to −3.9, P &lt; 0.00001) and less complications (OR: 0.47, 95 per cent CI: 0.25–0.88), P = 0.02] compared with patients undergoing ODP. There were no significant differences between the two groups in postoperative mortality and long‐term survival.ConclusionThe short‐term outcomes of LDP for pancreatic diseases were comparable with the open approach. Although ODP might be associated with shorter operative time and more lymph nodes harvested, individuals considering LDP might benefit from a shorter hospital stay and a faster resumption without an increase in postoperative morbidity and mortality.

Total Laparoscopic Distal Pancreatectomy: Beyond Selected Patients

Laparoscopic distal pancreatectomy (LDP) has emerged as the procedure of choice for selected patients. This study is to evaluate the feasibility of LDP and procedural outcomes in a series of consecutive nonselected patients. All patients undergoing distal pancreatectomy over 18 months were identified from a prospectively maintained database, under institutional review board approval. A completely laparoscopic (non hand-assisted) procedure was performed using a 4-trocar technique. Conversion to an open procedure, operative time (OR), estimated blood loss (EBL), transfusion requirements, postoperative length of stay (LOS), and complications were assessed. Sixteen patients were identified; 2/16 patients had undergone distal pancreatectomy as a component of another multiorgan open procedure, and were thus excluded. The remaining 14 patients had consented for LDP. Conversion occurred in 4/14 cases. Converted patients trended towards increased OR, EBL, and LOS (P = not significant). No mortalities occurred, and overall morbidities included: pancreatic fistula (n = 2), splenic abscess (n = 1), and pneumonia (n = 1). LDP-splenectomy (n = 3/14) was associated with both increased EBL (683 mL ± 388 vs 168 ± 141, P < 0.002) and increased transfusion rate (3/3 vs 3/11, P = 0.05), as compared with LDP-splenic preservation. LDP with splenic artery preservation (LDP-SAP) was completed in 7 of 14 patients, with less OR (2 hours 29 minutes ± 53 minutes vs 3 hours 40 minutes ± 1 hour, P < 0.05), a decreased transfusion rate (14% vs 71%, P = 0.05), and decreased LOS (2.8 days vs 6.8 days, P = 0.002) compared with LDP without SAP. Pathology was intraductal papillary mucinous neoplasm (IPMN) (n = 5), ductal carcinoma (n = 3), high grade dysphasia (n = 2), neuroendocrine tumor (n = 2), and pancreatitis (n = 2). Patients undergoing LDP-SAP demonstrated superior peri-procedural outcomes. This series of nonselected consecutive patients supports that LDP is technically feasible with a comparable procedural outcome to the selected-patient literature, suggesting potentially expanded indications for LDP.