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Laparoscopic and Open Distal Pancreatectomy-An Initial Single-Institution Experience with a Propensity Score Matching
Irena Plahuta1,2, Žan Šarenac2, Medeja Golob2
1Clinical Department of Abdominal and General Surgery, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia.
Life (Basel, Switzerland)
|January 25, 2025
Summary
Laparoscopic distal pancreatectomy shows promise for shorter pain management but has higher severe morbidity rates compared to open surgery. Further research is needed to mitigate postoperative complications in the laparoscopic approach.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Distal pancreatic neoplasms require surgical intervention.
- Laparoscopic distal pancreatectomy (LDP) offers a minimally invasive alternative to open distal pancreatectomy (ODP).
- Comparative outcomes between LDP and ODP require further investigation.
Purpose of the Study:
- To compare the safety and efficacy of LDP versus ODP for distal pancreatic neoplasms.
- To analyze postoperative morbidity, mortality, and oncological outcomes.
- To evaluate the potential benefits of LDP in terms of pain management.
Main Methods:
- Retrospective analysis of 400 pancreatectomies from a prospectively maintained database (2016-2023).
- Comparison between LDP (19 patients) and ODP (89 patients).
- Propensity score matching (PSM) analysis was employed to control for confounding factors.
Main Results:
- Severe morbidity was higher in the LDP group (47.4%) compared to the ODP-PSM group (15.8%), with a significant difference (p=0.034) attributed to Clavien-Dindo grade 3a complications.
- No significant difference was observed in 90-day mortality rates (3.3% ODP vs. 5.3% LDP/ODP-PSM).
- The LDP group demonstrated a shorter duration of intravenous narcotic analgesia (5 vs. 7 days, p=0.041) with comparable R0 resection and postoperative pancreatic fistula rates.
Conclusions:
- While LDP offers improved postoperative pain management, its current utilization is associated with higher severe morbidity, necessitating a focus on complication prevention.
- Oncological outcomes, including R0 resection rates, appear comparable between LDP and ODP.
- Further strategies are required to optimize the safety profile of laparoscopic distal pancreatectomy.
