Lending a hand for laparoscopic distal pancreatectomy: The optimal approach? Journal Article
| Authors: | Gamboa, A. C.; Aveson, V. G.; Zaidi, M. Y.; Lee, R. M.; Jarnagin, W. R.; Allen, P. J.; Drebin, J. A.; Kingham, T. P.; DeMatteo, R. P.; Sarmiento, J. M.; Russell, M. C.; Cardona, K.; Kooby, D. A.; D'Angelica, M. I.; Maithel, S. K. |
| Article Title: | Lending a hand for laparoscopic distal pancreatectomy: The optimal approach? |
| Abstract: | Background: Both minimally invasive surgery (MIS) and open approaches for distal pancreatectomy are acceptable. MIS options include total laparoscopic/robotic (TLR) and hand-assist laparoscopy (HAL). When considering safety profile and specimen quality, the optimal approach is unknown. Methods: Patients who underwent distal pancreatectomy from 2010-2018 at two major academic institutions were included. Converted procedures were categorized into final approach. Ninety-day perioperative/pathologic outcomes of MIS and open were compared. Subset analyses between TLR vs HAL and HAL vs open were performed. Intent-to-treat analysis was performed. Results: Among 1006 patients, resection was performed by MIS in 35% (n = 352), open in 65% (n = 654). MIS had similar patient comorbidity profile as open but had increased operative time (183 vs 162 min; p < 0.01), lower estimated-blood-loss (EBL; 131 vs 341 mL; p < 0.01), fewer intraoperative blood transfusions (1.4 vs 5%; p < 0.01), shorter LOS (5.2 vs 7.2 days; p < 0.01). Tumor size was smaller (3.2 vs 4.4 cm; p < 0.01) with lower lymph node (LN) yield (14 vs 16; p < 0.01). When comparing HAL (n = 109) to TLR (n = 243), despite increased prior abdominal operations (60 vs 43%; p = 0.008), HAL had shorter operative time (167 vs 191 min; p < 0.01), similar length-of-stay (LOS; 5.4 vs 5.1 days; p = 0.27), and readmission rate (15 vs 13%; p = 0.47). When comparing HAL to open, the advantages of TLR approach persisted including lower EBL (171 vs 342 mL; p < 0.01), and shorter LOS (5.4 vs 7.2 days; p < 0.01). Although HAL had smaller tumors, it had a similar LN yield (16 vs 16; p = 0.80), and higher R0-rate (97 vs 83%; p < 0.01). Conclusion: Hand-assist laparoscopy is safe and feasible for distal pancreatectomy as operative time, complication profile, lymph node yield, and R0-rates are similar to open procedures, while maintaining the associated the advantages of a total laparoscopic/robotic approach with reduced blood loss and shorter length-of-stay. © 2019 International Hepato-Pancreato-Biliary Association Inc. |
| Journal Title: | HPB |
| Volume: | 22 |
| Issue: | 5 |
| ISSN: | 1365-182X |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2020-05-01 |
| Start Page: | 690 |
| End Page: | 701 |
| Language: | English |
| DOI: | 10.1016/j.hpb.2019.09.007 |
| PUBMED: | 31601508 |
| PROVIDER: | scopus |
| PMCID: | PMC8385644 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 3 August 2020 -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
-
903Jarnagin -
777D'Angelica -
609Kingham -
165Drebin -
9Aveson
Related MSK Work