Laparoscopic Distal Pancreatectomy: Trends and Lessons Learned Through an 11-Year Experience
Journal of the American College of Surgeons, 05/29/2012
Kneuertz PJ et al. – This large, single–institution series demonstrates that despite a shift in patient selection to sicker patients with more proximal tumors, similar perioperative outcomes can be achieved with laparoscopic distal pancreatectomy. The CRS appears to be a reliable preoperative assessment tool for assessing other adverse perioperative outcomes in addition to predicting overall complications and fistulas as originally published.Methods
- Patients undergoing LDP between January 2000 and January 2011 were identified and divided into 2 equal groups to represent the early and recent experiences.
- Demographics, tumor characteristics, operative technique, and perioperative outcomes were examined and compared between groups.
- A CRS was calculated for the entire cohort and examined against observed outcomes.
- A total of 132 LDPs were attempted, of which 8 (6.1%) were converted to open procedures.
- Thirty–day overall and major complication rates were 43.2% and 12.9%, respectively, with mortality < 1%. Pancreatic fistulas occurred in 28 (21%) patients, of which 14 (11%) were clinically significant.
- Recent LDPs (n = 66) included patients with increasingly severe comorbidities (Charlson scores > 2, 40.9% vs 16.7%, p = 0.003), more proximal tumors (74.2% vs 26.2%, p < 0.001), more extended resections (10.6 vs 8.3 cm, p < 0.001), shorter operative times (141 vs 172 minutes, p = 0.007), and less frequent use of a hand port (25.8% vs 66.6%, p < 0.001).
- No significant differences were found in perioperative outcomes between the groups.
- As compared with the hand access technique, the total laparoscopic approach was associated with shorter hospital stays (5.3 vs 6.8 days, p = 0.032).
- Increasing CRS was associated with longer operative time, significant fistulas, wound infections, blood transfusions, major complications, ICU readmissions, and rehospitalizations.