Laparoscopic Distal Pancreatectomy for Pancreatic Cancer is Safe and Effective

Marita D Bauman, MD1, David C Becerra, MD2, E M Kilbane1, Nicholas J Zyromski, MD1, C M Schmidt, MD1, Attila Nakeeb, MD1, Michael G House, MD1, Eugene P Ceppa, MD1. 1Indiana University, 2Walter Reed National Military Medical Center

Purpose: To compare the short-term and oncologic outcomes of patients with pancreatic ductal adenocarcinoma (PDAC) undergoing laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (ODP).

Methods: Consecutive cases of distal pancreatectomy (n=422) were reviewed at a single high-volume institution over a 7-year period (2008-2014).  Inclusion criteria consisted of any patient with PDAC by surgical pathology. Ninety-day outcomes were monitored through a prospectively-maintained pancreatic resection database and the Social Security Death Index was used for 5-year survival. Two-way statistical analyses were used to compare categories; variance was reported with standard error of the mean; * indicates P value < 0.05.

Results: Eighty-one patients underwent distal pancreatectomy for PDAC. Thirty-five underwent LDP and 46 ODP. There were no statistical differences in demographics, BMI, and ASA classification.  Intraoperative and surgical pathology variables were also comparable for LDP vs. ODP: operative time (3.9 + 0.2 vs. 4.2 + 0.2 hours), duct size, gland texture, stump closure, tumor size (3.2 + 0.3cm vs. 4.0 + 0.4 cm), tumor stage (see table), and negative surgical margins (78% vs. 87%). Patients who underwent LDP experienced lower blood loss (310 + 68ml vs. 597 + 95ml; p=0.016*) and had fewer requiring transfusion (0 vs. 13; p=0.0004*). Those who underwent ODP had greater lymph node harvest (17.5 + 1.2 vs. 14.0 + 1.1; p=0.03*), more positive lymph nodes (1.6 + 0.29 vs. 0.77 + 0.24; p=0.03*), and a higher incidence of type C fistula (0% vs. 13%; p=0.03*). Post-operative outcomes are listed in the table. Median follow-up for all patients was 11.4 months. Long-term oncologic outcomes revealed similar outcomes including distant or local recurrence (28% vs. 52%; p=0.05) and median survival (17.9 vs. 15.1 months), as well as 1-year (71% vs. 59%), 3-year (17% vs. 13%), and 5-year (9% vs. 4%) survival for LDP and ODP respectively. 

Conclusions: As one of the largest single institution series of LDP for PDAC, these results suggest LDP as a safe surgical approach that is comparable from an oncologic standpoint to ODP for the management of PDAC.

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