TY - JOUR
T1 - A nationwide comparison of laparoscopic and open distal pancreatectomy for benign and malignant disease
AU - de Rooij, Thijs
AU - Jilesen, Anneke P.
AU - Boerma, Djamila
AU - Bonsing, Bert A.
AU - Bosscha, Koop
AU - van Dam, Ronald M.
AU - van Dieren, Susan
AU - Dijkgraaf, Marcel G.
AU - van Eijck, Casper H.
AU - Gerhards, Michael F.
AU - van Goor, Harry
AU - van der Harst, Erwin
AU - de Hingh, Ignace H.
AU - Kazemier, Geert
AU - Klaase, Joost M.
AU - Molenaar, I. Quintus
AU - Nieveen van Dijkum, Els J.
AU - Patijn, Gijs A.
AU - van Santvoort, Hjalmar C.
AU - Scheepers, Joris J.
AU - van der Schelling, George P.
AU - Sieders, Egbert
AU - Vogel, Jantien A.
AU - Busch, Olivier R.
AU - Besselink, Marc G.
PY - 2015
Y1 - 2015
N2 - Cohort studies from expert centers suggest that laparoscopic distal pancreatectomy (LDP) is superior to open distal pancreatectomy (ODP) regarding postoperative morbidity and length of hospital stay. But the generalizability of these findings is unknown because nationwide data on LDP are lacking. Adults who had undergone distal pancreatectomy in 17 centers between 2005 and 2013 were analyzed retrospectively. First, all LDPs were compared with all ODPs. Second, groups were matched using a propensity score. Third, the attitudes of pancreatic surgeons toward LDP were surveyed. The primary outcome was major complications (Clavien-Dindo grade ≥III). Among 633 included patients, 64 patients (10%) had undergone LDP and 569 patients (90%) had undergone ODP. Baseline characteristics were comparable, except for previous abdominal surgery and mean tumor size. In the full cohort, LDP was associated with fewer major complications (16% vs 29%; p = 0.02) and a shorter median [interquartile range, IQR] hospital stay (8 days [7-12 days] vs 10 days [8-14 days]; p = 0.03). Of all LDPs, 33% were converted to ODP. Matching succeeded for 63 LDP patients. After matching, the differences in major complications (9 patients [14%] vs 19 patients [30%]; p = 0.06) and median [IQR] length of hospital stay (8 days [7-12 days] vs 10 days [8-14 days]; p = 0.48) were not statistically significant. The survey demonstrated that 85% of surgeons welcomed LDP training. Despite nationwide underuse and an impact of selection bias, outcomes of LDP seemed to be at least noninferior to ODP. Specific training is welcomed and could improve both the use and outcomes of LDP
AB - Cohort studies from expert centers suggest that laparoscopic distal pancreatectomy (LDP) is superior to open distal pancreatectomy (ODP) regarding postoperative morbidity and length of hospital stay. But the generalizability of these findings is unknown because nationwide data on LDP are lacking. Adults who had undergone distal pancreatectomy in 17 centers between 2005 and 2013 were analyzed retrospectively. First, all LDPs were compared with all ODPs. Second, groups were matched using a propensity score. Third, the attitudes of pancreatic surgeons toward LDP were surveyed. The primary outcome was major complications (Clavien-Dindo grade ≥III). Among 633 included patients, 64 patients (10%) had undergone LDP and 569 patients (90%) had undergone ODP. Baseline characteristics were comparable, except for previous abdominal surgery and mean tumor size. In the full cohort, LDP was associated with fewer major complications (16% vs 29%; p = 0.02) and a shorter median [interquartile range, IQR] hospital stay (8 days [7-12 days] vs 10 days [8-14 days]; p = 0.03). Of all LDPs, 33% were converted to ODP. Matching succeeded for 63 LDP patients. After matching, the differences in major complications (9 patients [14%] vs 19 patients [30%]; p = 0.06) and median [IQR] length of hospital stay (8 days [7-12 days] vs 10 days [8-14 days]; p = 0.48) were not statistically significant. The survey demonstrated that 85% of surgeons welcomed LDP training. Despite nationwide underuse and an impact of selection bias, outcomes of LDP seemed to be at least noninferior to ODP. Specific training is welcomed and could improve both the use and outcomes of LDP
U2 - https://doi.org/10.1016/j.jamcollsurg.2014.11.010
DO - https://doi.org/10.1016/j.jamcollsurg.2014.11.010
M3 - Article
C2 - 25600974
SN - 1072-7515
VL - 220
SP - 263-270.e1
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 3
ER -