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Left-sided Pancreatectomy: A Multicenter Comparison of Laparoscopic and Open Approaches

Kooby, David A. MD*†; Gillespie, Theresa PhD*†; Bentrem, David MD‡; Nakeeb, Attila MD§; Schmidt, Max c. MD§; Merchant, Nipun B. MD¶; Parikh, Alex A. MD¶; Martin, Robert C. G. II MD∥; Scoggins, Charles R. MD, MBA∥; Ahmad, Syed MD**; Kim, Hong Jin MD††; Park, Jaemin BS*; Johnston, Fabian MD‡‡; Strouch, Matthew J. MD‡; Menze, Alex MD§; Rymer, Jennifer BS¶; McClaine, Rebecca MD**; Strasberg, Steven M. MD‡‡; Talamonti, Mark S. MD‡; Staley, Charles A. MD*†; McMasters, Kelly M. MD, PhD∥; Lowy, Andrew M. MD**; Byrd-Sellers, Johnita MS†; Wood, William C. MD*; Hawkins, William G. MD‡‡

doi: 10.1097/SLA.0b013e318185a990
Original Articles

Objectives: To compare perioperative outcomes of laparoscopic left-sided pancreatectomy (LLP) with traditional open left-sided pancreatectomy (OLP) in a multicenter experience.

Summary and Background Data: LLP is being performed more commonly with limited data comparing results with outcomes from OLP.

Methods: Data from 8 centers were combined for all cases performed between 2002–2006. OLP and LLP cohorts were matched by age, American Society of Anesthesiologists, resected pancreas length, tumor size, and diagnosis. Multivariate analysis was performed using binary logistic regression.

Results: Six hundred sixty-seven 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 margin rates (8% vs. 7%, P = 0.8), operative times (216 vs. 230 minutes, P = 0.3), or leak rates (18% vs. 11%, P = 0.1). LLP patients had lower average blood loss (357 vs. 588 mL, P < 0.01), fewer complications (40% vs. 57%, P < 0.01), and shorter hospital stays (5.9 vs. 9.0 days, P < 0.01). By MVA, LLP was an independent factor for shorter hospital stay (P < 0.01, odds ratio 0.33, 95% confidence interval 0.19–0.56).

Conclusions: In selected patients, LLP is associated with less morbidity and shorter LOS than OLP. Pancreatic fistula rates are similar for OLP and LLP. LLP is appropriate for selected patients with left-sided pancreatic pathology.

A multi-institutional study of 667 patients undergoing left pancreatectomy over 5 years was performed. Cohort-matched outcomes for open (N = 200) versus laparoscopic (N = 142) procedures were compared. No differences were seen in major complications or clinically significant fistula rates. Average hospital stay was 3 days shorter for patients undergoing laparoscopic left pancreatectomy.

From the *Department of Surgery, Emory University School of Medicine, Atlanta, Georgia; †Department of Surgery, Atlanta Veterans Affairs Medical Center, Decatur, Georgia; ‡Department of Surgery, Northwestern University Chicago, Illinois; §Department of Surgery, Indiana University, Indianapolis, Indiana; ¶Department of Surgery, Vanderbilt University, Nashville, Tennessee; ∥Department of Surgery, University of Louisville, Louisville, Kentucky; **Department of Surgery, Cincinnati University, Cincinnati, Ohio; ††Department of Surgery, University of North Carolina, Chapel Hill, North Carolina; and ‡‡Washington University, St. Louis, Missouri.

Supported by the Georgia Cancer Coalition.

Presented at the 128th American Surgical Association Annual Meeting New York, NY on April 24, 2008.

Reprints: David A. Kooby, MD, Winship Cancer Institute, Emory University School of Medicine, 1365C Clifton Rd, NE, 2nd floor, Atlanta, GA 30322. E-mail: dkooby@emory.edu.

© 2008 Lippincott Williams & Wilkins, Inc.