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01-09-2011

Perioperative and long-term results after left pancreatectomy: a single-institution, non-randomized, comparative study between open and laparoscopic approach

Authors: Giovanni Butturini, Stefano Partelli, Stefano Crippa, Giuseppe Malleo, Roberto Rossini, Luca Casetti, Gian Luigi Melotti, Micaela Piccoli, Paolo Pederzoli, Claudio Bassi

Published in: Surgical Endoscopy | Issue 9/2011

Abstract

Background

Laparoscopic left pancreatic resections are being increasingly performed. In this study, we provide a nonrandomized comparison between laparoscopic and open left pancreatectomy (OLP) for benign and borderline tumors, focusing on both perioperative and long-term results.

Methods

Demographic, pathologic, and perioperative details from patients who underwent laparoscopic and OLP between 1999 and 2006 were retrieved from our database and analyzed. Long-term results, including resume to full-time work, occurrence of incisional hernias, and incidence of exocrine and endocrine insufficiency also were evaluated.

Results

A total of 116 patients were included in the analysis; 43 (37.1%) were managed laparoscopically and 73 (62.9%) underwent the open procedure. There were no significant differences regarding clinical and pathological data. All of the resections attempted laparoscopically were completed. The rate of splenic preservation was significantly higher in the laparoscopic group (P = 0.0001). Postoperative outcomes were similar between the two groups. Longitudinal comparison between two time periods (1999–June 2004 vs. July 2004–2006) showed that pancreatic fistula and hospital stay significantly diminished over time in the laparoscopic group (P = 0.04 and P = 0.004, respectively). Median follow-up was 53 months. The incidence of exocrine insufficiency and incisional hernias was significantly higher after open resections (both P = 0.05). After hospital discharge, median time to resume full-time work was 6 weeks in the open group and 3 weeks after laparoscopic resections (P < 0.0001). Laparoscopy also resulted as an independent factor for an early resume to full-time activities in the multivariate analysis (P < 0.0001).

Conclusions

Laparoscopic left pancreatectomy is a safe procedure for benign and borderline tumors, with similar perioperative outcomes compared with the open procedure. In the long term, the laparoscopic approach is likely to be superior thanks to a more rapid resume of full-time activities and to the lower incidence of incisional hernias and exocrine insufficiency. Clearly, these results have yet to be confirmed in large, randomized trials.

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Title: Perioperative and long-term results after left pancreatectomy: a single-institution, non-randomized, comparative study between open and laparoscopic approach
Authors: Giovanni Butturini
Stefano Partelli
Stefano Crippa
Giuseppe Malleo
Roberto Rossini
Luca Casetti
Gian Luigi Melotti
Micaela Piccoli
Paolo Pederzoli
Claudio Bassi
Publication date: 01-09-2011
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 9/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-011-1634-0

At a glance: The STEP trials

Springer Medicine

Perioperative and long-term results after left pancreatectomy: a single-institution, non-randomized, comparative study between open and laparoscopic approach

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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