gms | German Medical Science

Background: The aim of this study was to assess intra-operative, post-operative and oncologic outcome in patients undergoing open distal pancreatectomy (ODP) or laparoscopic distal pancreatectomy (LDP) for benign and malign lesions of the pancreas identified from a prospectively maintained national database.

Materials and methods: Data from patients undergoing distal pancreatic resection were extracted from the national quality registry for pancreatic surgery (StudoQ Pankreas) of the German Association for General and Visceral Surgery. The groups of LDP and ODP were compared regarding demography, co-morbidities, operative details, histopathology and peri-operative outcome.

Results: Data from 212 patients undergoing ODP or LDP from 2013 to July 2015 at 25 surgical departments were included. Co-morbidities were well-balanced. Patients in the LPD group were younger and more frequently female, and had more IPMN (21%) and NET (31%) while PDAC was more frequent among ODP patients (35%). Rates of intended (71%) and achieved (77%) spleen preservation were significantly higher in LDP, while multivisceral resection was[TK1] more often performed during OPD (20%). Incidence of POPF (37%), DGE (13%), PPH (13%), intra-abdominal abscess (7%), burst abdomen (2%) and Clavien Dindo Classification were statistically balanced in ODP and LDP patients. There was a trend for decreased surgical site infection with LDP (13% vs 24%; p=0,09). Unplanned post-operative mechanical ventilation was less frequent in the LDP group (0% vs 7%, p=0,05) and LDP patients had a shorter intensive care unit stay (median 1 day vs 2 days, p<0,01) as well as overall hospital stay (10 days vs 14 days; p<0,01). Median number of lymph nodes harvested (10 vs 14; p=0,17) and frequency of margin negative resections (83% vs 72%, p=0.56) were similar in both groups.

Conclusion: LDP was performed in a selected group of patients. There was a higher rate of spleen preservation and least non-inferiority in terms of major post-operative morbidity and oncologic safety when compared to ODP. LDP patients had less unplanned mechanical ventilation, shorter ICU stay and shorter overall hospital stay.