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

Abstract

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

Abbreviations

PDAC:

Pancreatic ductal adenocarcinoma

MIS:

Minimally invasive surgery

DP:

Distal pancreatectomy

LDP:

Laparoscopic distal pancreatectomy

ODP:

Open distal pancreatectomy

PSM:

Propensity score matching

LN:

Lymph node

ITT:

Intention-to-treat

ISGPF:

International Study Group on Pancreatic Fistula

POPF:

Postoperative pancreatic fistula

CR-POPF:

Clinically relevant POPF

RFS:

Recurrence-free survival

OS:

Overall survival

SD:

Standard deviation

DGE:

Delayed gastric emptying

NCDB:

National cancer database

RAMPS:

Radical antegrade modular pancreatosplenectomy

MDCT:

Multi-detector computed tomography scan

BMI:

Body mass index

ASA:

American Society of Anesthesiologists

RBC:

Red blood cell

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Funding

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

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Correspondence to Yong Wang or Xian-fa Wang.

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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). https://doi.org/10.1007/s13304-020-00742-5

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Keywords

  • Laparoscopy
  • Pancreatectomy
  • Adenocarcinoma
  • Morbidity
  • Survival