Laparoscopic versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: a single-center propensity score matching study


Laparoscopic distal pancreatectomy (LDP) for benign and low-grade malignant pancreatic diseases has been increasingly utilized. However, the use of LDP for pancreatic ductal adenocarcinoma (PDAC) remains controversial and has not been widely accepted. In this study, the outcomes of LDP versus conventional open distal pancreatectomy (ODP) for left-sided PDAC were examined. A retrospective review of patients who underwent LDP or ODP for left-sided PDAC between January 2010 and January 2019 was conducted. One-to-one propensity score matching (PSM) was used to minimize selection biases by balancing factors including age, sex, ASA grade, tumor size, and combined resection. Demographic data, their pathological and short-term clinical parameters, and long-term oncological outcomes were compared between the LDP and ODP groups. A total of 197 patients with PDAC were enrolled. There were 115 (58.4%) patients in the LDP group and 82 (41.6%) patients in the ODP group. After 1:1 PSM, 66 well-matched patients in each group were evaluated. The LDP group had lesser blood loss (195 vs. 210 mL, p < 0.01), shorter operative time (193.6 vs. 217.5 min; p = 0.02), and shorter hospital stay (12 vs. 15 days, p < 0.01), whereas the overall complication rates were comparable between groups (10.6% vs.16.7%, p = 0.31). There were no significant differences between the LDP and ODP groups regarding 3-year recurrence-free or overall survival rate (p = 0.89 and p = 0.33, respectively). LDP in the treatment of left-sided PDAC is a technically safe, feasible and favorable approach in short-term surgical outcomes. Moreover, patients undergoing LDP than ODP for PDAC had comparable oncological metrics and similar middle-term survival rate.

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Fig. 1



Pancreatic ductal adenocarcinoma


Minimally invasive surgery


Distal pancreatectomy


Laparoscopic distal pancreatectomy


Open distal pancreatectomy


Propensity score matching


Lymph node




International Study Group on Pancreatic Fistula


Postoperative pancreatic fistula


Clinically relevant POPF


Recurrence-free survival


Overall survival


Standard deviation


Delayed gastric emptying


National cancer database


Radical antegrade modular pancreatosplenectomy


Multi-detector computed tomography scan


Body mass index


American Society of Anesthesiologists


Red blood cell


  1. 1.

    Buanes TA (2014) Pancreatic cancer-improved care achievable. World J Gastroenterol 20(30):10405–10418

    PubMed  PubMed Central  Google Scholar 

  2. 2.

    Chiaravalli M, Reni M, O’Reilly EM (2017) Pancreatic ductal adenocarcinoma: state-of-the-art 2017 and new therapeutic strategies. Cancer Treat Rev 60:32–43

    PubMed  Google Scholar 

  3. 3.

    Gawande A (2012) Two hundred years of surgery. N Engl J Med 366(18):1716–1723

    CAS  PubMed  Google Scholar 

  4. 4.

    Tran Cao HS, Lopez N, Chang DC, Lowy AM, Bouvet M, Baumgartner JM, Talamini MA, Sicklick JK (2014) Improved perioperative outcomes with minimally invasive distal pancreatectomy: results from a population-based analysis. JAMA Surg 149(3):237–243

    PubMed  Google Scholar 

  5. 5.

    Anderson B, Karmali S (2014) Laparoscopic resection of pancreatic adenocarcinoma: dream or reality? World J Gastroenterol 20(39):14255–14262

    PubMed  PubMed Central  Google Scholar 

  6. 6.

    Nakamura M, Wakabayashi G, Miyasaka Y, Tanaka M, Morikawa T, Unno M, Tajima H, Kumamoto Y, Satoi S, Kwon M, Toyama H, Ku Y, Yoshitomi H, Nara S, Shimada K, Yokoyama T, Miyagawa S, Toyama Y, Yanaga K, Fujii T, Kodera Y, Tomiyama Y, Miyata H, Takahara T, Beppu T, Yamaue H, Miyazaki M, Takada T (2015) Multicenter comparative study of laparoscopic and open distal pancreatectomy using propensity score-matching. J Hepatobiliary Pancreat Sci 22(10):731–736

    PubMed  Google Scholar 

  7. 7.

    Mehrabi A, Hafezi M, Arvin J, Esmaeilzadeh M, Garoussi C, Emami G, Kossler-Ebs J, Muller-Stich BP, Buchler MW, Hackert T, Diener MK (2015) A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: it’s time to randomize. Surgery 157(1):45–55

    PubMed  Google Scholar 

  8. 8.

    de Rooij T, van Hilst J, van Santvoort H, Boerma D, van den Boezem P, Daams F, van Dam R, Dejong C, van Duyn E, Dijkgraaf M, van Eijck C, Festen S, Gerhards M, Groot Koerkamp B, de Hingh I, Kazemier G, Klaase J, de Kleine R, van Laarhoven C, Luyer M, Patijn G, Steenvoorde P, Suker M, Abu Hilal M, Busch O, Besselink M (2019) Minimally invasive versus open distal pancreatectomy (LEOPARD): a multicenter patient-blinded randomized controlled trial. Ann Surg 269(1):2–9

    PubMed  Google Scholar 

  9. 9.

    Raoof M, Ituarte PHG, Woo Y, Warner SG, Singh G, Fong Y, Melstrom L (2018) Propensity score-matched comparison of oncological outcomes between laparoscopic and open distal pancreatic resection. Br J Surg 105(5):578–586

    CAS  PubMed  Google Scholar 

  10. 10.

    de Rooij T, Klompmaker S, Abu Hilal M, Kendrick ML, Busch OR, Besselink MG (2016) Laparoscopic pancreatic surgery for benign and malignant disease. Nat Rev Gastroenterol Hepatol 13(4):227–238

    PubMed  Google Scholar 

  11. 11.

    de Rooij T, Besselink MG, Shamali A, Butturini G, Busch OR, Edwin B, Troisi R, Fernandez-Cruz L, Dagher I, Bassi C, Abu Hilal M (2016) Pan-European survey on the implementation of minimally invasive pancreatic surgery with emphasis on cancer. HPB 18(2):170–176

    PubMed  Google Scholar 

  12. 12.

    van Hilst J, de Rooij T, Abu Hilal M, Asbun HJ, Barkun J, Boggi U, Busch OR, Conlon KC, Dijkgraaf MG, Han HS, Hansen PD, Kendrick ML, Montagnini AL, Palanivelu C, Rosok BI, Shrikhande SV, Wakabayashi G, Zeh HJ, Vollmer CM, Kooby DA, Besselink MG (2017) Worldwide survey on opinions and use of minimally invasive pancreatic resection. HPB 19(3):190–204

    PubMed  Google Scholar 

  13. 13.

    Chen K, Pan Y, Mou YP, Wang GY, Zhang RC, Yan JF, Jin WW, Zhang MZ, Chen QL, Wang XF (2019) Evolution of laparoscopic pancreatic resections for pancreatic and periampullary diseases: perioperative outcomes of 605 patients at a high-volume center. J Laparoendosc Adv Surg Tech Part A 29(9):1085–1092

    Google Scholar 

  14. 14.

    Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–591

    PubMed  Google Scholar 

  15. 15.

    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    PubMed  PubMed Central  Google Scholar 

  16. 16.

    Wittekind C, Compton C, Quirke P, Nagtegaal I, Merkel S, Hermanek P, Sobin LH (2009) A uniform residual tumor (R) classification: integration of the R classification and the circumferential margin status. Cancer 115(15):3483–3488

    PubMed  Google Scholar 

  17. 17.

    Zhang M, Fang R, Mou Y, Chen R, Xu X, Zhang R, Yan J, Jin W, Ajoodhea H (2015) LDP vs ODP for pancreatic adenocarcinoma: a case matched study from a single-institution. BMC Gastroenterol 15:182.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Tol JA, Gouma DJ, Bassi C, Dervenis C, Montorsi M, Adham M, Andren-Sandberg A, Asbun HJ, Bockhorn M, Buchler MW, Conlon KC, Fernandez-Cruz L, Fingerhut A, Friess H, Hartwig W, Izbicki JR, Lillemoe KD, Milicevic MN, Neoptolemos JP, Shrikhande SV, Vollmer CM, Yeo CJ, Charnley RM (2014) Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery 156(3):591–600

    PubMed  Google Scholar 

  19. 19.

    Oettle H, Neuhaus P, Hochhaus A, Hartmann JT, Gellert K, Ridwelski K, Niedergethmann M, Zulke C, Fahlke J, Arning MB, Sinn M, Hinke A, Riess H (2013) Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA 310(14):1473–1481

    CAS  PubMed  Google Scholar 

  20. 20.

    Shin SH, Kim SC, Song KB, Hwang DW, Lee JH, Lee D, Lee JW, Jun E, Park KM, Lee YJ (2015) A comparative study of laparoscopic vs. open distal pancreatectomy for left-sided ductal adenocarcinoma: a propensity score-matched analysis. J Am Coll Surg 220(2):177–185.

    Article  PubMed  Google Scholar 

  21. 21.

    Sulpice L, Farges O, Goutte N, Bendersky N, Dokmak S, Sauvanet A, Delpero JR (2015) Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: time for a randomized controlled trial? Results of an all-inclusive national observational study. Ann Surg 262(5):868–873. 873-864)

    Article  PubMed  Google Scholar 

  22. 22.

    Strasberg SM, Drebin JA, Linehan D (2003) Radical antegrade modular pancreatosplenectomy. Surgery 133(5):521–527

    PubMed  Google Scholar 

  23. 23.

    Abe T, Ohuchida K, Miyasaka Y, Ohtsuka T, Oda Y, Nakamura M (2016) Comparison of Surgical outcomes between radical antegrade modular pancreatosplenectomy (RAMPS) and standard retrograde pancreatosplenectomy (SPRS) for left-sided pancreatic cancer. World J Surg 40(9):2267–2275

    PubMed  Google Scholar 

  24. 24.

    Zhou Y, Shi B, Wu L, Si X (2017) A systematic review of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas. HPB 19(1):10–15

    CAS  PubMed  Google Scholar 

  25. 25.

    Park HJ, You DD, Choi DW, Heo JS, Choi SH (2014) Role of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas. World J Surg 38(1):186–193

    PubMed  Google Scholar 

  26. 26.

    Latorre M, Ziparo V, Nigri G, Balducci G, Cavallini M, Ramacciato G (2013) Standard retrograde pancreatosplenectomy versus radical antegrade modular pancreatosplenectomy for body and tail pancreatic adenocarcinoma. Am Surg 79(11):1154–1158

    PubMed  Google Scholar 

  27. 27.

    Kim EY, You YK, Kim DG, Hong TH (2016) Initial experience with radical antegrade modular pancreatosplenectomy in a single institution. Ann Surg Treat Res 91(1):29–36

    PubMed  PubMed Central  Google Scholar 

  28. 28.

    Lee SH, Kang CM, Hwang HK, Choi SH, Lee WJ, Chi HS (2014) Minimally invasive RAMPS in well-selected left-sided pancreatic cancer within Yonsei criteria: long-term (> median 3 years) oncologic outcomes. Surg Endosc 28(10):2848–2855

    PubMed  Google Scholar 

  29. 29.

    Asbun HJ, Moekotte AL, Vissers FL, Kunzler F, Cipriani F, Alseidi A, D’Angelica MI, Balduzzi A, Bassi C, Bjornsson B, Boggi U, Callery MP, Del Chiaro M, Coimbra FJ, Conrad C, Cook A, Coppola A, Dervenis C, Dokmak S, Edil BH, Edwin B, Giulianotti PC, Han HS, Hansen PD, van der Heijde N, van Hilst J, Hester CA, Hogg ME, Jarufe N, Jeyarajah DR, Keck T, Kim SC, Khatkov IE, Kokudo N, Kooby DA, Korrel M, de Leon FJ, Lluis N, Lof S, Machado MA, Demartines N, Martinie JB, Merchant NB, Molenaar IQ, Moravek C, Mou YP, Nakamura M, Nealon WH, Palanivelu C, Pessaux P, Pitt HA, Polanco PM, Primrose JN, Rawashdeh A, Sanford DE, Senthilnathan P, Shrikhande SV, Stauffer JA, Takaori K, Talamonti MS, Tang CN, Vollmer CM, Wakabayashi G, Walsh RM, Wang SE, Zinner MJ, Wolfgang CL, Zureikat AH, Zwart MJ, Conlon KC, Kendrick ML, Zeh HJ, Hilal MA, Besselink MG (2020) The Miami international evidence-based guidelines on minimally invasive pancreas resection. Ann Surg 271(1):1–14

    PubMed  Google Scholar 

  30. 30.

    Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA, Asbun HJ, Bassi C, Buchler M, Charnley RM, Conlon K, Cruz LF, Dervenis C, Fingerhutt A, Friess H, Gouma DJ, Hartwig W, Lillemoe KD, Montorsi M, Neoptolemos JP, Shrikhande SV, Takaori K, Traverso W, Vashist YK, Vollmer C, Yeo CJ, Izbicki JR (2014) Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 155(6):977–988

    PubMed  Google Scholar 

  31. 31.

    Pietrasz D, Marthey L, Wagner M, Blanc JF, Laurent C, Turrini O, Raoul JL, Terrebonne E, Hentic O, Trouilloud I, Coriat R, Regenet N, Innominato P, Taieb J, Cunha AS, Bachet JB (2015) Pathologic major response after FOLFIRINOX is prognostic for patients secondary resected for borderline or locally advanced pancreatic adenocarcinoma: an AGEO-FRENCH, prospective, multicentric Cohort. Ann Surg Oncol 22(3):015–4783

    Google Scholar 

  32. 32.

    Katz MH, Shi Q, Ahmad SA, Herman JM, Marsh Rde W, Collisson E, Schwartz L, Frankel W, Martin R, Conway W, Truty M, Kindler H, Lowy AM, Bekaii-Saab T, Philip P, Talamonti M, Cardin D, LoConte N, Shen P, Hoffman JP, Venook AP (2016) Preoperative modified FOLFIRINOX treatment followed by capecitabine-based chemoradiation for borderline resectable pancreatic cancer: alliance for clinical trials in oncology trial A021101. JAMA Surg 151(8):17

    Google Scholar 

  33. 33.

    Jegatheeswaran S, Baltatzis M, Jamdar S, Siriwardena AK (2017) Superior mesenteric artery (SMA) resection during pancreatectomy for malignant disease of the pancreas: a systematic review. HPB 19(6):483–490

    PubMed  Google Scholar 

  34. 34.

    Mollberg N, Rahbari NN, Koch M, Hartwig W, Hoeger Y, Buchler MW, Weitz J (2011) Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg 254(6):882–893

    PubMed  Google Scholar 

  35. 35.

    Kooby DA, Hawkins WG, Schmidt CM, Weber SM, Bentrem DJ, Gillespie TW, Sellers JB, Merchant NB, Scoggins CR, Martin RC 3rd, Kim HJ, Ahmad S, Cho CS, Parikh AA, Chu CK, Hamilton NA, Doyle CJ, Pinchot S, Hayman A, McClaine R, Nakeeb A, Staley CA, McMasters KM, Lillemoe KD (2010) A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? J Am Coll Surg 210(5):779–785.

    Article  PubMed  Google Scholar 

  36. 36.

    Magge D, Gooding W, Choudry H, Steve J, Steel J, Zureikat A, Krasinskas A, Daouadi M, Lee KK, Hughes SJ, Zeh HJ 3rd, Moser AJ (2013) Comparative effectiveness of minimally invasive and open distal pancreatectomy for ductal adenocarcinoma. JAMA Surg 148(6):525–531.

    Article  PubMed  Google Scholar 

  37. 37.

    Stauffer JA, Coppola A, Villacreses D, Mody K, Johnson E, Li Z, Asbun HJ (2017) Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc 31(5):2233–2241

    PubMed  Google Scholar 

  38. 38.

    Stiles ZE, Dickson PV, Deneve JL, Glazer ES, Dong L, Wan JY, Behrman SW (2018) The impact of unplanned conversion to an open procedure during minimally invasive pancreatectomy. J Surg Res 227:168–177

    PubMed  Google Scholar 

  39. 39.

    Rehman S, John SK, Lochan R, Jaques BC, Manas DM, Charnley RM, French JJ, White SA (2014) Oncological feasibility of laparoscopic distal pancreatectomy for adenocarcinoma: a single-institution comparative study. World J Surg 38(2):476–483.

    CAS  Article  PubMed  Google Scholar 

  40. 40.

    Mendoza AS 3rd, Han HS, Ahn S, Yoon YS, Cho JY, Choi Y (2016) Predictive factors associated with postoperative pancreatic fistula after laparoscopic distal pancreatectomy: a 10-year single-institution experience. Surg Endosc 30(2):649–656

    PubMed  Google Scholar 

  41. 41.

    Sahakyan MA, Kazaryan AM, Rawashdeh M, Fuks D, Shmavonyan M, Haugvik SP, Labori KJ, Buanes T, Rosok BI, Ignjatovic D, Abu Hilal M, Gayet B, Kim SC, Edwin B (2016) Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: results of a multicenter cohort study on 196 patients. Surg Endosc 30(8):3409–3418

    PubMed  Google Scholar 

  42. 42.

    Sanchez-Cabus S, Adam JP, Pittau G, Gelli M, Cunha AS (2016) Laparoscopic left pancreatectomy: early results after 115 consecutive patients. Surg Endosc 30(10):4480–4488

    PubMed  Google Scholar 

  43. 43.

    de Rooij T, Cipriani F, Rawashdeh M, van Dieren S, Barbaro S, Abuawwad M, van Hilst J, Fontana M, Besselink MG, Abu Hilal M (2017) Single-surgeon learning curve in 111 laparoscopic distal pancreatectomies: does operative time tell the whole story? J Am Coll Surg 224(5):826–832

    PubMed  Google Scholar 

  44. 44.

    Dokmak S, Fteriche FS, Aussilhou B, Levy P, Ruszniewski P, Cros J, Vullierme MP, Khoy Ear L, Belghiti J, Sauvanet A (2017) The largest European single-center experience: 300 laparoscopic pancreatic resections. J Am Coll Surg 225(2):226–234

    PubMed  Google Scholar 

  45. 45.

    Diener MK, Seiler CM, Rossion I, Kleeff J, Glanemann M, Butturini G, Tomazic A, Bruns CJ, Busch OR, Farkas S, Belyaev O, Neoptolemos JP, Halloran C, Keck T, Niedergethmann M, Gellert K, Witzigmann H, Kollmar O, Langer P, Steger U, Neudecker J, Berrevoet F, Ganzera S, Heiss MM, Luntz SP, Bruckner T, Kieser M, Buchler MW (2011) Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. Lancet 377(9776):1514–1522

    PubMed  Google Scholar 

  46. 46.

    Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM Jr (2013) A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg 216(1):1–14.

    Article  PubMed  Google Scholar 

  47. 47.

    Panni RZ, Guerra J, Hawkins WG, Hall BL, Asbun HJ, Sanford DE (2019) National pancreatic fistula rates after minimally invasive pancreaticoduodenectomy: a NSQIP analysis. J Am Coll Surg 21(19):30151–30156

    Google Scholar 

  48. 48.

    di Sebastiano P, Grottola T, di Mola FF (2016) Borderline resectable pancreatic cancer and the role of neoadjuvant chemoradiotherapy. Updates Surg 68(3):235–239

    PubMed  Google Scholar 

  49. 49.

    Valls C, Andia E, Sanchez A, Fabregat J, Pozuelo O, Quintero JC, Serrano T, Garcia-Borobia F, Jorba R (2002) Dual-phase helical CT of pancreatic adenocarcinoma: assessment of resectability before surgery. Am J Roentgenol 178(4):821–826

    Google Scholar 

  50. 50.

    Walters DM, Lapar DJ, de Lange EE, Sarti M, Stokes JB, Adams RB, Bauer TW (2011) Pancreas-protocol imaging at a high-volume center leads to improved preoperative staging of pancreatic ductal adenocarcinoma. Ann Surg Oncol 18(10):2764–2771

    PubMed  PubMed Central  Google Scholar 

  51. 51.

    Allen VB, Gurusamy KS, Takwoingi Y, Kalia A, Davidson BR (2016) Diagnostic accuracy of laparoscopy following computed tomography (CT) scanning for assessing the resectability with curative intent in pancreatic and periampullary cancer. Cochrane Database Syst Rev 6(7):CD009323

    Google Scholar 

  52. 52.

    Gaujoux S, Allen PJ (2010) Role of staging laparoscopy in peri-pancreatic and hepatobiliary malignancy. World J Gastrointest Surg 2(9):283–290

    PubMed  PubMed Central  Google Scholar 

  53. 53.

    Delpero JR, Bachellier P, Regenet N, Le Treut YP, Paye F, Carrere N, Sauvanet A, Autret A, Turrini O, Monges-Ranchin G, Boher JM (2014) Pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a French multicentre prospective evaluation of resection margins in 150 evaluable specimens. HPB 16(1):20–33

    PubMed  Google Scholar 

  54. 54.

    Esposito I, Kleeff J, Bergmann F, Reiser C, Herpel E, Friess H, Schirmacher P, Buchler MW (2008) Most pancreatic cancer resections are R1 resections. Ann Surg Oncol 15(6):1651–1660

    PubMed  Google Scholar 

  55. 55.

    Delpero JR, Jeune F, Bachellier P, Regenet N, Le Treut YP, Paye F, Carrere N, Sauvanet A, Adham M, Autret A, Poizat F, Turrini O, Boher JM (2017) Prognostic value of resection margin involvement after pancreaticoduodenectomy for Ductal adenocarcinoma: updates from a french prospective multicenter study. Ann Surg 266(5):787–796

    PubMed  Google Scholar 

  56. 56.

    van Hilst J, Korrel M, de Rooij T, Lof S, Busch OR, Groot Koerkamp B, Kooby DA, van Dieren S, Abu Hilal M, Besselink MG (2019) Oncologic outcomes of minimally invasive versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: a systematic review and meta-analysis. Eur J Surg Oncol 45(5):719–727

    PubMed  Google Scholar 

  57. 57.

    van Hilst J, de Rooij T, Klompmaker S, Rawashdeh M, Aleotti F, Al-Sarireh B, Alseidi A, Ateeb Z, Balzano G, Berrevoet F, Bjornsson B, Boggi U, Busch OR, Butturini G, Casadei R, Del Chiaro M, Chikhladze S, Cipriani F, van Dam R, Damoli I, van Dieren S, Dokmak S, Edwin B, van Eijck C, Fabre JM, Falconi M, Farges O, Fernandez-Cruz L, Forgione A, Frigerio I, Fuks D, Gavazzi F, Gayet B, Giardino A, Groot Koerkamp B, Hackert T, Hassenpflug M, Kabir I, Keck T, Khatkov I, Kusar M, Lombardo C, Marchegiani G, Marshall R, Menon KV, Montorsi M, Orville M, de Pastena M, Pietrabissa A, Poves I, Primrose J, Pugliese R, Ricci C, Roberts K, Rosok B, Sahakyan MA, Sanchez-Cabus S, Sandstrom P, Scovel L, Solaini L, Soonawalla Z, Souche FR, Sutcliffe RP, Tiberio GA, Tomazic A, Troisi R, Wellner U, White S, Wittel UA, Zerbi A, Bassi C, Besselink MG, Abu Hilal M (2019) Minimally invasive versus open distal pancreatectomy for Ductal adenocarcinoma (DIPLOMA): a Pan-European Propensity Score matched study. Ann Surg 269(1):10–17

    PubMed  Google Scholar 

  58. 58.

    Chen K, Pan Y, Zhang B, Maher H, Cai XJ (2018) Laparoscopic versus open pancreatectomy for pancreatic ductal adenocarcinoma: a systematic review and meta-analysis. Int J Surg 53:243–256

    PubMed  Google Scholar 

  59. 59.

    Sharpe SM, Talamonti MS, Wang E, Bentrem DJ, Roggin KK, Prinz RA, Marsh RD, Stocker SJ, Winchester DJ, Baker MS (2015) The laparoscopic approach to distal pancreatectomy for ductal adenocarcinoma results in shorter lengths of stay without compromising oncologic outcomes. Am J Surg 209(3):557–563

    PubMed  Google Scholar 

  60. 60.

    Kantor O, Bryan DS, Talamonti MS, Lutfi W, Sharpe S, Winchester DJ, Prinz RA, Baker MS (2017) Laparoscopic distal pancreatectomy for cancer provides oncologic outcomes and overall survival identical to open distal pancreatectomy. J Gastrointest Surg 21(10):1620–1625

    PubMed  Google Scholar 

  61. 61.

    Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagorney DM, Kendrick ML (2014) Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Annals of surgery 260(4):633–638. 638-640)

    Article  PubMed  Google Scholar 

  62. 62.

    Nussbaum DP, Adam MA, Youngwirth LM, Ganapathi AM, Roman SA, Tyler DS, Sosa JA, Blazer DG 3rd (2016) Minimally invasive pancreaticoduodenectomy does not improve use or time to initiation of adjuvant chemotherapy for patients with pancreatic adenocarcinoma. Ann Surg Oncol 23(3):1026–1033

    PubMed  Google Scholar 

  63. 63.

    Kim HW, Lee JC, Lee J, Kim JW, Kim J, Hwang JH (2017) Early versus delayed initiation of adjuvant treatment for pancreatic cancer. PLoS One 12(3):e0173960

    PubMed  PubMed Central  Google Scholar 

  64. 64.

    Mirkin KA, Greenleaf EK, Hollenbeak CS, Wong J (2016) Time to the initiation of adjuvant chemotherapy does not impact survival in patients with resected pancreatic cancer. Cancer 122(19):2979–2987

    CAS  PubMed  Google Scholar 

  65. 65.

    Perinel J, Adham M (2016) ERAS and pancreatic surgery: a review. Updates Surg 68(3):253–255

    CAS  PubMed  Google Scholar 

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This research was supported by Scientific and Technological Project of Zhejiang Province (Grant Nos. 2017C33094, LGF19H150007, LY20H160020, LGF20H030009).

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Chen, K., Tong, Q., Yan, J. et al. Laparoscopic versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: a single-center propensity score matching study. Updates Surg 72, 387–397 (2020).

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  • Laparoscopy
  • Pancreatectomy
  • Adenocarcinoma
  • Morbidity
  • Survival