Laparoscopic Vs Open Left (distal) Pancreatectomy- A Case-matched Comparative Study.

Objectives: Laparoscopic left pancreatectomy (LLP) is increasingly being performed with technical advancements in minimally invasive surgery. We reviewed our institutional series of left pancreatectomy cases and present a case-matched study evaluating the outcomes of LLP compared to matched patients undergoing OLP.

Methods: All institutional left pancreatectomy procedures performed from June 2002 to June 2009 were studied by retrospective chart review. LLP and OLP cohorts were matched by age, gender, and gross pathology of the tumor (solid or cystic). Perioperative outcomes and final pathology were compared. Continuous variables were compared by using the t-test.

Results: Ninety three left pancreatectomies were performed with 21 attempted laparoscopically, and 17 completed laparoscopically. The final comparison groups included all 17 LLP cases and 17 matched OLP cases. 8 patients in each group were female(47%) and 9 male (53%). In each group, left pancreatectomy was performed for solid lesions in 8(47%) patients and for cystic lesions in 9(53%) patients. Age ranged from 41-82 years (mean 61 years). Mean operative time for LLP was 373 minutes (range 189- 680) and for OLP was 342 minutes (196-726). Blood loss in LLP was 202 ml (25-1000), and in OLP was 395ml (50-1000). Length of stay in LLP was 7.4 days (5-14 days) and in OLP was 8.8 days (6-21 days). Mean length of pancreas specimen was 8.2cm in the LLP and 8.8 in OLP. Average size of tumor in LLP was 2.9cm (0.8 – 4.9 cm) and in OLP was 4.5cm (0.8 to 17cm). None of the margins were positive in either the groups. Complications in the LLP group occurred in 10 patients, out of which 3 patients were major. Total complications in the OLP group were seen in 7 patients, out of which 3 were major. 4 cases of postoperative pancreatic fistulae (PPF) were found in the LLP group where as in the OLP group there were 6 cases of PPF. Among the 4 cases in the LLP group one was grade A, 2 were grade B, and one was grade C PPF. In the OLP group two each of A, B, C grade fistulae were seen.

Conclusion: in selected patients LLP is associated with shorter length of stay, less operative blood loss and is equally effective as OLP. In selected patients LLP should be the treatment of choice.

VariableLLPOLPp value
Age61 [41-82]61 [28-82]0.934
Operative Time [min373 [189- 680]342 [196-726]0.853
Blood loss [mL]202 [25-1000395 [50-1000]0.104
Length of Stay [days]7.4 [5-14]8.8 [6-21]0.100
Length of pancreas specimen [cm]8.28.8
Tumor size [cm]2.9 [0.8-4.9]4.5 [0.8-17]
(+) Margins00
Any complication10/177/17
Serious complication3/173/17
Post-op Pancreatic Fistula4/176/17
Fistula Grade1A:2B:1C2A:2B:2C

Session: Poster

Program Number: P430

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