Masafumi Nakamura1,2, Go Wakabayashi3, Yoshihiro Miyasaka2, Masao Tanaka2, Takanori Morikawa4, Michiaki Unno4, Hiroshi Tajima5, Yusuke Kumamoto5, Sohei Satoi6, Masanori Kwon6, Hirochika Toyama7, Yonson Ku7, Hideyuki Yoshitomi8, Satoshi Nara9, Kazuaki Shimada9, Takahide Yokoyama10, Shinichi Miyagawa10, Yoichi Toyama11, Katsuhiko Yanaga11, Tsutomu Fujii12, Yasuhiro Kodera12, Yasuyuki Tomiyama13, Hiroaki Miyata14, Takeshi Takahara3, Toru Beppu15, Hiroki Yamaue16, Masaru Miyazaki8, Tadahiro Takada17. 1. Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, Japan. 2. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 3. Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan. 4. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan. 5. Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan. 6. Department of Surgery, Kansai Medical University, Hirakata, Japan. 7. Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. 8. Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. 9. Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan. 10. First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan. 11. The Jikei University School of Medicine, Tokyo, Japan. 12. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan. 13. Department of Hepatology and Pancreatology, Kawasaki Medical School, Kurashiki, Japan. 14. Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 15. Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan. 16. Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan. 17. Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Abstract
BACKGROUND: Laparoscopic distal pancreatectomy has been shown to be associated with favorable postoperative outcomes using meta-analysis. However, there have been no randomized controlled studies yet. This study aimed to compare laparoscopic and open distal pancreatectomy using propensity score-matching. METHODS: We retrospectively collected perioperative data of 2,266 patients who underwent distal pancreatectomy in 69 institutes from 2006-2013 in Japan. Among them, 2,010 patients were enrolled in this study and divided into two groups, laparoscopic distal pancreatectomy and open distal pancreatectomy. Perioperative outcomes were compared between the groups using unmatched and propensity matched analysis. RESULTS: After propensity score-matching, laparoscopic distal pancreatectomy was associated with favorable perioperative outcomes compared with open distal pancreatectomy, including higher rate of preservation of spleen and splenic vessels (P < 0.001); lower rates of intraoperative transfusion (P = 0.020), clinical grade of pancreatic fistula (International Study Group on Pancreatic Fistula grade B and C; P < 0.001), and morbidity (P < 0.001); and shorter hospital stay (P = 0.001), but a longer operative time (P < 0.001). CONCLUSIONS: Laparoscopic distal pancreatectomy was associated with more favorable perioperative outcomes than open distal pancreatectomy.
BACKGROUND: Laparoscopic distal pancreatectomy has been shown to be associated with favorable postoperative outcomes using meta-analysis. However, there have been no randomized controlled studies yet. This study aimed to compare laparoscopic and open distal pancreatectomy using propensity score-matching. METHODS: We retrospectively collected perioperative data of 2,266 patients who underwent distal pancreatectomy in 69 institutes from 2006-2013 in Japan. Among them, 2,010 patients were enrolled in this study and divided into two groups, laparoscopic distal pancreatectomy and open distal pancreatectomy. Perioperative outcomes were compared between the groups using unmatched and propensity matched analysis. RESULTS: After propensity score-matching, laparoscopic distal pancreatectomy was associated with favorable perioperative outcomes compared with open distal pancreatectomy, including higher rate of preservation of spleen and splenic vessels (P < 0.001); lower rates of intraoperative transfusion (P = 0.020), clinical grade of pancreatic fistula (International Study Group on Pancreatic Fistula grade B and C; P < 0.001), and morbidity (P < 0.001); and shorter hospital stay (P = 0.001), but a longer operative time (P < 0.001). CONCLUSIONS: Laparoscopic distal pancreatectomy was associated with more favorable perioperative outcomes than open distal pancreatectomy.
Authors: Thijs de Rooij; Sjors Klompmaker; Mohammad Abu Hilal; Michael L Kendrick; Olivier R Busch; Marc G Besselink Journal: Nat Rev Gastroenterol Hepatol Date: 2016-02-17 Impact factor: 46.802
Authors: Sang Hyup Han; In Woong Han; Jin Seok Heo; Seong Ho Choi; Dong Wook Choi; Sunjong Han; Yung Hun You Journal: Surg Endosc Date: 2017-06-29 Impact factor: 4.584