PURPOSE: To compare the short-term and oncologic outcomes of patients with pancreatic ductal adenocarcinoma (PDAC) undergoing laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (ODP). METHODS: Consecutive cases of distal pancreatectomy (DP) (n = 422) were reviewed at a single high-volume institution over a 10-year period (2005-2014). Inclusion criteria consisted of any patient with PDAC by surgical pathology. Ninety-day outcomes were monitored through a prospectively maintained pancreatic resection database. The Social Security Death Index was used for 5-year survival. Two-way statistical analyses were used to compare categories; variance was reported with standard error of the mean; * indicates P value <0.05. RESULTS: Seventy-nine patients underwent DP for PDAC. Thirty-three underwent LDP and 46 ODP. There were no statistical differences in demographics, BMI, and ASA classification. Intraoperative and surgical pathology variables were comparable for LDP versus ODP: operative time (3.9 ± 0.2 vs. 4.2 ± 0.2 h), duct size, gland texture, stump closure, tumor size (3.3 ± 0.3 vs. 4.0 ± 0.4 cm), lymph node harvest (14.5 ± 1.1 vs. 17.5 ± 1.2), tumor stage (see table), and negative surgical margins (77 vs. 87%). Patients who underwent LDP experienced lower blood loss (310 ± 68 vs. 597 ± 95 ml; P = 0.016*) and required fewer transfusions (0 vs. 13; P = 0.0008*). Patients who underwent LDP had fewer positive lymph nodes (0.8 ± 0.2 vs. 1.6 ± 0.3; P = 0.04*) and a lower incidence of type C pancreatic fistula (0 vs. 13%; P = 0.03*). Median follow-up for all patients was 11.4 months. Long-term oncologic outcomes revealed similar outcomes including distant or local recurrence (30 vs. 52%; P = 0.05) and median survival (18 vs. 15 months), as well as 1-year (73 vs. 59%), 3-year (22 vs. 21%), and 5-year (20 vs. 15%) survival for LDP and ODP, respectively. CONCLUSIONS: The results of this series suggest that LDP is a safe surgical approach that is comparable from an oncologic standpoint to ODP for the management of pancreatic adenocarcinoma.
PURPOSE: To compare the short-term and oncologic outcomes of patients with pancreatic ductal adenocarcinoma (PDAC) undergoing laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (ODP). METHODS: Consecutive cases of distal pancreatectomy (DP) (n = 422) were reviewed at a single high-volume institution over a 10-year period (2005-2014). Inclusion criteria consisted of any patient with PDAC by surgical pathology. Ninety-day outcomes were monitored through a prospectively maintained pancreatic resection database. The Social Security Death Index was used for 5-year survival. Two-way statistical analyses were used to compare categories; variance was reported with standard error of the mean; * indicates P value <0.05. RESULTS: Seventy-nine patients underwent DP for PDAC. Thirty-three underwent LDP and 46 ODP. There were no statistical differences in demographics, BMI, and ASA classification. Intraoperative and surgical pathology variables were comparable for LDP versus ODP: operative time (3.9 ± 0.2 vs. 4.2 ± 0.2 h), duct size, gland texture, stump closure, tumor size (3.3 ± 0.3 vs. 4.0 ± 0.4 cm), lymph node harvest (14.5 ± 1.1 vs. 17.5 ± 1.2), tumor stage (see table), and negative surgical margins (77 vs. 87%). Patients who underwent LDP experienced lower blood loss (310 ± 68 vs. 597 ± 95 ml; P = 0.016*) and required fewer transfusions (0 vs. 13; P = 0.0008*). Patients who underwent LDP had fewer positive lymph nodes (0.8 ± 0.2 vs. 1.6 ± 0.3; P = 0.04*) and a lower incidence of type C pancreatic fistula (0 vs. 13%; P = 0.03*). Median follow-up for all patients was 11.4 months. Long-term oncologic outcomes revealed similar outcomes including distant or local recurrence (30 vs. 52%; P = 0.05) and median survival (18 vs. 15 months), as well as 1-year (73 vs. 59%), 3-year (22 vs. 21%), and 5-year (20 vs. 15%) survival for LDP and ODP, respectively. CONCLUSIONS: The results of this series suggest that LDP is a safe surgical approach that is comparable from an oncologic standpoint to ODP for the management of pancreatic adenocarcinoma.
Authors: Sandeep S Vijan; Kamran A Ahmed; William S Harmsen; Florencia G Que; Kaye M Reid-Lombardo; David M Nagorney; John H Donohue; Michael B Farnell; Michael L Kendrick Journal: Arch Surg Date: 2010-07
Authors: S Rehman; S K P John; R Lochan; B C Jaques; D M Manas; R M Charnley; J J French; S A White Journal: World J Surg Date: 2014-02 Impact factor: 3.352
Authors: David A Kooby; William G Hawkins; C Max Schmidt; Sharon M Weber; David J Bentrem; Theresa W Gillespie; Johnita Byrd Sellers; Nipun B Merchant; Charles R Scoggins; Robert C G Martin; Hong Jin Kim; Syed Ahmad; Clifford S Cho; Alexander A Parikh; Carrie K Chu; Nicholas A Hamilton; Courtney J Doyle; Scott Pinchot; Amanda Hayman; Rebecca McClaine; Attila Nakeeb; Charles A Staley; Kelly M McMasters; Keith D Lillemoe Journal: J Am Coll Surg Date: 2010-05 Impact factor: 6.113
Authors: Ki Byung Song; Song Cheol Kim; Jae Berm Park; Young Hoon Kim; Young Soo Jung; Myung-Hwan Kim; Sung-Koo Lee; Dong-Wan Seo; Sang Soo Lee; Do Hyun Park; Duck Jong Han Journal: Surg Endosc Date: 2011-05-10 Impact factor: 4.584
Authors: Paolo Limongelli; Andrea Belli; Gianluca Russo; Luigi Cioffi; Alberto D'Agostino; Corrado Fantini; Giulio Belli Journal: Surg Endosc Date: 2012-01-19 Impact factor: 4.584
Authors: Thijs de Rooij; Anneke P Jilesen; Djamila Boerma; Bert A Bonsing; Koop Bosscha; Ronald M van Dam; Susan van Dieren; Marcel G Dijkgraaf; Casper H van Eijck; Michael F Gerhards; Harry van Goor; Erwin van der Harst; Ignace H de Hingh; Geert Kazemier; Joost M Klaase; I Quintus Molenaar; Els J Nieveen van Dijkum; Gijs A Patijn; Hjalmar C van Santvoort; Joris J Scheepers; George P van der Schelling; Egbert Sieders; Jantien A Vogel; Olivier R Busch; Marc G Besselink Journal: J Am Coll Surg Date: 2014-11-20 Impact factor: 6.113
Authors: Deepa Magge; William Gooding; Haroon Choudry; Jennifer Steve; Jennifer Steel; Amer Zureikat; Alyssa Krasinskas; Mustapha Daouadi; Kenneth K W Lee; Steven J Hughes; Herbert J Zeh; A James Moser Journal: JAMA Surg Date: 2013-06 Impact factor: 14.766
Authors: Heidi Nelson; Daniel J Sargent; H Sam Wieand; James Fleshman; Mehran Anvari; Steven J Stryker; Robert W Beart; Michael Hellinger; Richard Flanagan; Walter Peters; David Ota Journal: N Engl J Med Date: 2004-05-13 Impact factor: 91.245
Authors: Shukri F Khuri; William G Henderson; Jennifer Daley; Olga Jonasson; R Scott Jones; Darrell A Campbell; Aaron S Fink; Robert M Mentzer; Janet E Steeger Journal: J Am Coll Surg Date: 2007-06 Impact factor: 6.113