Laparoscopic distal pancreatectomy: Evolution of a technique at a single institution Journal Article
| Authors: | Jayaraman, S.; Gonen, M.; Brennan, M. F.; D'Angelica, M. I.; DeMatteo, R. P.; Fong, Y.; Jarnagin, W. R.; Allen, P. J. |
| Article Title: | Laparoscopic distal pancreatectomy: Evolution of a technique at a single institution |
| Abstract: | 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. © 2010 by the American College of Surgeons. |
| Keywords: | adult; controlled study; treatment outcome; middle aged; retrospective studies; major clinical study; gastrointestinal hemorrhage; patient selection; pancreas resection; pancreatic neoplasms; outcome assessment; laparoscopy; laparoscopic surgery; adenocarcinoma; postoperative complication; length of stay; hospitalization; body mass; lymph node; operation duration; pancreatectomy; pancreas disease; surgical patient; pancreas fistula |
| Journal Title: | Journal of the American College of Surgeons |
| Volume: | 211 |
| Issue: | 4 |
| ISSN: | 1072-7515 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2010-10-01 |
| Start Page: | 503 |
| End Page: | 509 |
| Language: | English |
| DOI: | 10.1016/j.jamcollsurg.2010.06.010 |
| PUBMED: | 20868976 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Export Date: 20 April 2011" - "CODEN: JACSE" - "Source: Scopus" |
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