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Laparoscopic vs Open Distal Pancreatectomy: A Comparative Study of Perioperative Outcomes
Onur Kutlu*, Katherine A. Morgan, Megan L. Walters, David Adams
Surgery, Medical University of South Carolina, Charleston, SC
Objective:
To assess the perioperative outcomes of laparoscopic and open distal pancreatectomy patients for various etiologies.
Material and Methods:
All Pancreas Database at a single institution was queried for patients who underwent distal pancreatectomy (DP) between August 2012 and September 2015. Patients who underwent previous gastrointestinal surgery were excluded from the study. Patients were grouped as open (ODP) and laparoscopic DP (LDP) and perioperative outcomes were recorded. Intergroup comparisons were performed with Fishers exact test for categorical variables and students t tests for continuous variables. Binary logistic regression analyses were performed to evaluate the factors contributing for significantly different complications. Statistical analyses were performed with SPSS 21.
Results:
Of the 157 patients, 138 fit out criteria. 98 (67.2%) underwent ODP and 40 (32.8%) underwent LDP. 54% were Female (46.9% ODP vs 70% LDP)p=0.01, mean age was 57(56 ODP vs 59 LDP) p= 0.25. Diagnoses were chronic pancreatitis 31%, ductal carcinoma 18.8%, IPMN 14.5%, Cystic tumors 10.9%, NET 13%, Solid Pseudopapillary Neoplasm 5.1%, other 6.5%. Median post-op stay was 6 days (6 ODP vs 5 LDP ) p=0.038, and mean ICU stay was (1.3 ODP, 1LDP)p=0.026. There were no perioperative deaths. Mean operative time was 139 min (144 ODP vs 173 LDP) P=0.2, blood loss was 439 ml (564 vs 137)p=0.001. Post-op complications were delayed gastric emptying in 17 (14 vs 3)p=0.03, superficial surgical site infection in 6(5 vs 1) p=0.17, deep surgical site infection(DSSI) in 24(21 vs 3) p=0.04, pneumonia in 11 (10 vs 1) p=0.02, pulmonary embolism in 5 (3 vs 2) p=0.2, DVT in 4 (3 vs 1) p=0.7, post-operative pancreatic fistula(POPF) in 34 (29 vs 10)p=0.01, Clinically significant pancreatic fistula in 3(3 vs 0) p=0.7, readmission in 30 (21 vs 8)p=0.7. Factors associated with POPF were increased BMI, chronic pancreatitis and alcohol abuse. Factors associated with pneumonia were length of surgery, POPF. The risk factors for DSSI were gender, tobacco use and POPF.
Conclusion:
LDP provides shorter postoperative lengths of stay, decreased blood loss and no significant increase in rates of readmission compared to ODP without compromising perioperative outcomes.
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