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04.11.2016 | Original Article | Ausgabe 2/2017

International Journal of Colorectal Disease 2/2017

Laparoscopic versus open distal pancreatectomy—a propensity score-matched analysis from the German StuDoQ|Pancreas registry

Zeitschrift:
International Journal of Colorectal Disease > Ausgabe 2/2017
Autoren:
Ulrich Friedrich Wellner, Hryhoriy Lapshyn, Detlef K. Bartsch, Ioannis Mintziras, Ulrich Theodor Hopt, Uwe Wittel, Hans-Jörg Krämling, Hubert Preissinger-Heinzel, Matthias Anthuber, Bernd Geissler, Jörg Köninger, Katharina Feilhauer, Merten Hommann, Luisa Peter, Natascha C. Nüssler, Thomas Klier, Ulrich Mansmann, Tobias Keck, The StuDoQ Pancreas study group and members of StuDoQ|Pancreas registry of the German Society for General and Visceral Surgery (DGAV)

Abstract

Purpose

The aim of this study was to assess intraoperative, postoperative, and oncologic outcome in patients undergoing laparoscopic distal pancreatectomy (LDP) versus open distal pancreatectomy (ODP) for benign and malignant lesions of the pancreas.

Methods

Data from patients undergoing distal pancreatic resection were extracted from the StuDoQ|Pancreas registry of the German Society for General and Visceral Surgery. After propensity score case matching, groups of LDP and ODP were compared regarding demography, comorbidities, operative details, histopathology, and perioperative outcome.

Results

At the time of data extraction, the StuDoQ|Pancreas registry included over 3000 pancreatic resections from over 50 surgical departments in Germany. Data from 353 patients undergoing ODP (n = 254) or LDP (n = 99) from September 2013 to February 2016 at 29 institutions were included in the analysis. Baseline data showed a strong selection bias in LDP patients, which disappeared after 1:1 propensity score matching. A comparison of the matched groups disclosed a significantly longer operation time, higher rate of spleen preservation, more grade A pancreatic fistula, shorter hospital stay, and increased readmissions for LDP. In the small group of patients operated for pancreatic cancer, a lower lymph node yield with a lower lymph node ratio was apparent in LDP.

Conclusions

LDP needed more time but potential advantages include increased spleen preservation and shorter hospital stay, as well as a trend for less transfusion, ventilation, and mortality. LDP for pancreatic cancer was performed rarely and will need critical evaluation in the future. Data from a prospective randomized registry trial is needed to confirm these results.

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