Laparoscopic distal pancreatectomy: evolution of a technique at a single institution.

BACKGROUND: The pancreas remains an organ for which routine laparoscopic resection is uncommon. STUDY
DESIGN: This is a review of all distal pancreatectomies performed between January 2003 and December 2009 at Memorial Sloan-Kettering Cancer Center. Variables were compared between laparoscopic and open groups in unmatched and matched analyses.
RESULTS: During the 7-year study period, 343 distal pancreatectomies were performed; 107 (31%) were attempted laparoscopically and 236 (69%) were performed open. The conversion rate was 30%. Laparoscopic patients were younger (median 60 vs 64 years, p < 0.0001), experienced less blood loss (median 150 vs 350 mL, p < 0.0001), longer operative times (median 163 vs 194 minutes, p < 0.0001), shorter hospital stay (median 5 vs 7 days, p < 0.0001), and had fewer postoperative complications (27% vs 40%, p = 0.03) than open patients. The rates of complications of grade 3 or greater (20% vs 20%, p = NS) and pancreatic leak (15% vs 13%, p = NS) were similar between laparoscopic and open groups. Patients having procedures that were converted had a higher body mass index (BMI) than patients who did not (28 vs 25, p = 0.035). Patients with converted resections experienced higher rates of complications of grade 3 or greater (36% vs 20%, p = 0.008) and pancreatic leaks (27% vs 13%, p = 0.03) than open patients. Compared with matched open patients, laparoscopic patients had longer operative times (195 minutes vs 160 minutes, p < 0.0001), less blood loss (175 mL vs 300 mL, p < 0.0001), and shorter hospital stay (5 days vs 6 days, p < 0.001).
CONCLUSIONS: Patients who had laparoscopic distal pancreatectomy experienced decreased blood loss and a shorter hospital stay compared with matched patients undergoing open resection. Careful patient selection is important because patients who required conversion experienced higher rates of complications and pancreatic leak.