Laparoscopic vs open distal pancreatectomy for adenocarcinoma: A single-institution comparative study.

Ariel Ferraro, MD1, Maria Clotilde Gancedo, MD1, Javier Crisci2, Fernando Dip, MD1, Alejandro Rolle, MD2. 1BUENOS AIRES UNIVERSITY, 2Sanatorio Parque. Rosario

BACKGROUND: Laparoscopic distal pancreatectomy (LDP) is performed increasingly for pancreatic pathology in the body and tail of the pancreas. Few reports in the literature evaluate the comparison between the open and laparoscopic approach for malignant lesions of the body and tail of the pancreas. We Evaluate the technical aspects and oncological outcomes of the laparoscopic and open approach for adenocarcinoma of the body and tail of the pancreas

METHODS: Between 2012 – 2013  twenty five distal pancreatectomies were performed. An initial series of 8 patients with distal pancreatic adenocarcinoma that underwent  distal laparoscopic or open pancreatectomy  was compared and prospectlevely analized. Complication rate, blood lost , tumor size , margin resections , number of nodes dissected , free survival rate and and recurrence was evaluated in the laparoscopic and open approach .-  Data were analysed using SPSS(®) v19 utilising standard tests. A p value <0.05 was considered significant.

RESULTS: Out of 25  patients who underwent distal pancreatectomy between 2012 and 2014, 8 had histologically confirmed adenocarcinoma (LDP n = 4, ODP n = 4). No difference was founded between both groups when size of tumor was compared.  (LDP 27.7 vs. ODP 31.25 mm, p > 0.05). Complete resection (R0) was achieved in all cases.No difference in the number of lymph nodes was informed between both groups. (LDP 11.75 vs. ODP 11.25, p > 0.05). No intraoperative complication was reported . Blood loss was 232 ml in the ODP group compared 175 in  the LDP group. A longer operative time was noted for LDP (305 vs. 257 min, p < 0.05). Patient  were discharged before in LDP compared to the ODP(LDP5.5  vs  ODP 7.25  days, p < 0.05). No leaks were founded in any of the 8 patients evaluated. Overall disease free survival rate also was similar in both groups.   (LDP 28.25  vs  ODP 27  months , p  > 0.05)

CONCLUSIONS: Laparoscopic treatment of distal adenocarcinoma seems to have the same oncological outcomes when compared to  the open procedure.  Even though the laparoscopic approach  prolonged the operative time we founded a decrease in the blood lost and hospital stay. 

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