Minimally Invasive Distal Pancreatectomy Improves Outcomes Compared to Open at a Rural Tertiary Care Center

Horatiu C Dancea, MD, Vladan N Obradovic, MD, Nicole L Woll, PhD, Mohsen M Shabahang, MD PhD, Joseph A Blansfield, MD. Geisinger Medical Center, Danville, PA

 

Background:
As surgeons become more adept at minimally invasive techniques, more surgeries are being tackled laparoscopically. Laparoscopic pancreatic surgery requires considerable expertise in both pancreatic and laparoscopic surgery; therefore laparoscopic pancreatic resections have been less common than other surgical techniques. Most reports of laparoscopic pancreatic resection have come from major academic centers. Our goal is to investigate clinical outcomes of laparoscopic distal pancreatectomy (LDP) compared to open distal pancreatectomy (ODP) at our institution.

Methods:
We reviewed all patients who underwent distal pancreatectomy from 1999 to 2011 at our institution.

Results
Sixty six patients underwent distal pancreatectomy at our institution during this time period. Thirty-five patients had ODP and 31 underwent LDP. The average age in our total population was 60 years. The average BMI in our patient population was 29.7 kg/m². The majority of our patients were women (38 patients, 58%). The groups were evenly matched in terms of age, gender and BMI.

The majority of patients undergoing distal pancreatectomy had benign lesions. There was no significant difference in the histology between the groups. Fourteen patients had pancreatic adenocarcinoma, 4 in the laparoscopic and 10 in the open group (P=0.14). Of those, only one patient had a positive margin on pathology. That patient was in the open group. For patients who had neoplastic lesions, average tumor size was 4.3 cm. The average tumor size was larger in the laparoscopic group but this difference was not significant (5.2 cm versus 3.85 cm, p=0.25).

Operative times were significantly shorter for LDP (246 minutes versus 309; p=0.02). Blood loss was significantly higher in the open group (438 versus 208 ml; p=0.02). There were no conversions from laparoscopic to open procedure.

The most common complication in our patients was intra-abdominal fluid collection or abscess in 10 patients, 6 in the LDP group and 4 in the ODP group. Pancreatic fistula rates for our total population was 11% and was slightly higher in the open versus the laparoscopic group (5/35 (14%) versus 2/31 (6%), p=0.43). Hospital stay was shorter in LDP group but this did not reach statistical significance (6.4 versus 8 days; p=0.08). There was no 30 day mortality.

Conclusions:
Complication rates after open and laparoscopic pancreatectomy in our series are equivalent, similar to those reported from major academic centers, with pancreatic leak continuing to be the most significant factor.

While achieving similar outcomes, laparoscopic approach does lead to decreased operative time and blood loss, shorter hospital stay and less wound complications.

Laparoscopic distal pancreatectomy is safe when performed at a rural tertiary care center.


Session Number: Poster – Poster Presentations
Program Number: P390
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