Topic: C. Clinical GI
Multicenter Analysis of 667 Left Pancreatectomies: Should the Laparoscopic Approach Become Standard?
David A Kooby1, Theresa Gillespie1, David J Bentrem2, Attila Nakeeb3, Nipun Merchant4, Robert C. Martin5, Sayed A. Ahmad6, Hongjin Kim7, William C Wood1, William G Hawkins8
1Emory University, Atlanta, GA;2Northwestern University, Chicago, IL;3Indiana University, Indianapolis, IN;4Vanderbilt University, Nashville, TN;5University of Louisville, Louisville, KY;6University of Cincinnati, Cincinnati, OH;7University of North Carolina, Chapel Hill, NC;8Washington University, St. Louis, MO
OBJECTIVES: Laparoscopic left pancreatectomy (LLP) is being performed more commonly. We compared early outcomes of LLP to standard open left pancreatectomy (OLP).
METHODS: Data from 8 centers were combined for all left pancreatectomies (LP) performed between 2002-2006. An OLP cohort was matched by age, ASA, resected pancreas length, tumor size, and diagnosis. Multivariate analysis (MVA) for hospital length of stay (LOS) was performed using binomial logistic regression.
RESULTS: During the 5 years, 667 LPs were performed, with 159 (24%) attempted laparoscopically. Indications were solid lesion in 307 (46%), cystic in 295 (44%), and pancreatitis in 65 (10%) cases. Positive margins occurred in 51 (8%) cases, 335 (50%) had complications, and significant leaks occurred in 108 (16%). Conversion to OLP occurred in 20 (13%) of the LLPs. In the matched comparison, 200 OLPs were compared with 142 LLPs. There were no differences in positive margins (8 vs 7%, p=0.8), operative times (216 vs 230 min, p=0.3), or leak rates (18 vs. 11%, p=0.1). LLP patients had lower blood loss (357 vs. 588 cc, p<0.01), fewer complications (40 vs. 57%, p<0.01), and shorter hospital stays (5.9 vs. 9.0 days, p<0.01). In MVA, LLP maintained its independent relation to shorter hospital stays (Table).CONCLUSIONS: LLP is associated with less morbidity and shorter LOS than OLP. Pancreatic fistula formation is no higher with LLP. This analysis merits prospective comparison.
| Factor | P value | Odds ratio | 95% CI |
| Age <65 | <0.01 | 0.43 | 0.25-0.71 |
| ASA 1 or 2 | 0.08 | 0.63 | 0.39-1.05 |
| Male sex | 0.65 | 1.13 | 0.67-1.90 |
| Benign disease | 0.13 | 0.67 | 0.40-1.13 |
| No complication | <0.01 | 0.32 | 0.19-0.55 |
| LLP | <0.01 | 0.33 | 0.19-0.56 |