Comparative Analysis of Clinical Outcomes Between Laparoscopic and Open Central Pancreatectomy : Case -Control Study

songcheol Kim, kibyung Song, Haeran Ha, Haeryun Seo, Jaebum Park, Yunghun Kim, duckjong Han, Yunbaik Choi. Depetment of surgery, Ulsan University College of Medicine and Asan Medical Center

Aim : Despite recent advances in laparoscopic pancreatic surgery, few studies have compared laparoscopic central pancreatectomy (LCP) with open central pancreatectomy (OCP). This study aimed to compare clinical outcomes between for LCP and OCP as a case-control study as a single, high-volume institutional study.

Material &Methods : In the study period (From year of 2006 to Aug. 2010), we performed 400 cases of laparoscopic pancreatic resection. Among them 24 cases of LCP and 49 cases of OCP were matched by age, body mass index(BMI), past medical history, previous abdominal operation, major length of resected pancreas, tumor size, and pathologic diagnosis.

Results : Main indications were benign or low grade malignant disease in both groups. There were no significant difference in mean operative time (293min vs 274.6min, p=0.373), mean blood loss (2.55mg/dl vs 2.39dg/dl, p=0.822), the patient’s number of red blood cell transfusion (7cases vs 19cases, p=0.428) between the LCP and OCP groups. Bowel movement return to normal and resumption of normal diet were achieved 4.46 ± 2.08 days after the operation in the LCP group and 5.43 ± 1.27 days after the operation in the OCP group (p=0.044). The mean duration of hospital stay was 15.9 days for the LCP group, which was significantly shorter than the 21.6 days for the OCP group (p=0.029). There were no new onset postoperative diabetes mellitus in LCP group. The overall complication rate was 33.3%(8cases) in the LCP group and and 38.8%(19case) in the OCP group, which is not significantly different (p=0.656).

Conclusion : The use of LCP for the benign or low grade malignant lesions of the pancreatic body and neck portion is feasible and safe. The laparoscopic approach to central pancreatectomy appears to provide advantages of early resumption of normal diet, reduction of postoperative hospital stay, and prevention of new onset postoperative diabetes mellitus without any further complications compared to open method.