TY - JOUR
T1 - A Nationwide Comparison of Laparoscopic and Open Distal Pancreatectomy for Benign and Malignant Disease
AU - de Rooij, Thijs
AU - Jilesen, Anneke P.
AU - Boerma, Djamila
AU - Bonsing, Bert A.
AU - Bosscha, Koop
AU - van Dam, Ronald M.
AU - van Dieren, Susan
AU - Dijkgraaf, Marcel G.
AU - van Eijck, Casper H.
AU - Gerhards, Michael F.
AU - van Goor, Harry
AU - van der Harst, Erwin
AU - de Hingh, Ignace H.
AU - Kazemier, Geert
AU - Klaase, Joost M.
AU - Molenaar, I. Quintus
AU - van Dijkum, Els J. Nieveen
AU - Patijn, Gijs A.
AU - van Santvoort, Hjalmar C.
AU - Scheepers, Joris J.
AU - van der Schelling, George P.
AU - Sieders, Egbert
AU - Vogel, Jantien A.
AU - Busch, Olivier R.
AU - Besselink, Marc G.
AU - Dutch Pancreatic Canc Grp
PY - 2015/3
Y1 - 2015/3
N2 - BACKGROUND: Cohort studies from expert centers suggest that laparoscopic distal pancreatectomy (LDP) is superior to open distal pancreatectomy (ODP) regarding postoperative morbidity and length of hospital stay. But the generalizability of these findings is unknown because nationwide data on LDP are lacking.STUDY DESIGN: Adults who had undergone distal pancreatectomy in 17 centers between 2005 and 2013 were analyzed retrospectively. First, all LDPs were compared with all ODPs. Second, groups were matched using a propensity score. Third, the attitudes of pancreatic surgeons toward LDP were surveyed. The primary outcome was major complications (Clavien-Dindo grade >= III).RESULTS: Among 633 included patients, 64 patients (10%) had undergone LDP and 569 patients (90%) had undergone ODP. Baseline characteristics were comparable, except for previous abdominal surgery and mean tumor size. In the full cohort, LDP was associated with fewer major complications (16% vs 29%; p = 0.02) and a shorter median [interquartile range, IQR] hospital stay (8 days [7-12 days] vs 10 days [8-14 days]; p = 0.03). Of all LDPs, 33% were converted to ODP. Matching succeeded for 63 LDP patients. After matching, the differences in major complications (9 patients [14%] vs 19 patients [30%]; p = 0.06) and median [IQR] length of hospital stay (8 days [7-12 days] vs 10 days [8-14 days]; p = 0.48) were not statistically significant. The survey demonstrated that 85% of surgeons welcomed LDP training.CONCLUSIONS: Despite nationwide underuse and an impact of selection bias, outcomes of LDP seemed to be at least noninferior to ODP. Specific training is welcomed and could improve both the use and outcomes of LDP. (C) 2015 by the American College of Surgeons
AB - BACKGROUND: Cohort studies from expert centers suggest that laparoscopic distal pancreatectomy (LDP) is superior to open distal pancreatectomy (ODP) regarding postoperative morbidity and length of hospital stay. But the generalizability of these findings is unknown because nationwide data on LDP are lacking.STUDY DESIGN: Adults who had undergone distal pancreatectomy in 17 centers between 2005 and 2013 were analyzed retrospectively. First, all LDPs were compared with all ODPs. Second, groups were matched using a propensity score. Third, the attitudes of pancreatic surgeons toward LDP were surveyed. The primary outcome was major complications (Clavien-Dindo grade >= III).RESULTS: Among 633 included patients, 64 patients (10%) had undergone LDP and 569 patients (90%) had undergone ODP. Baseline characteristics were comparable, except for previous abdominal surgery and mean tumor size. In the full cohort, LDP was associated with fewer major complications (16% vs 29%; p = 0.02) and a shorter median [interquartile range, IQR] hospital stay (8 days [7-12 days] vs 10 days [8-14 days]; p = 0.03). Of all LDPs, 33% were converted to ODP. Matching succeeded for 63 LDP patients. After matching, the differences in major complications (9 patients [14%] vs 19 patients [30%]; p = 0.06) and median [IQR] length of hospital stay (8 days [7-12 days] vs 10 days [8-14 days]; p = 0.48) were not statistically significant. The survey demonstrated that 85% of surgeons welcomed LDP training.CONCLUSIONS: Despite nationwide underuse and an impact of selection bias, outcomes of LDP seemed to be at least noninferior to ODP. Specific training is welcomed and could improve both the use and outcomes of LDP. (C) 2015 by the American College of Surgeons
KW - INTERNATIONAL STUDY-GROUP
KW - SINGLE-INSTITUTION
KW - PERIOPERATIVE OUTCOMES
KW - HOSPITAL MORTALITY
KW - SURGERY ISGPS
KW - METAANALYSIS
KW - PANCREATICODUODENECTOMY
KW - COMPLICATIONS
KW - DEFINITION
KW - SPLEEN
U2 - 10.1016/j.jamcollsurg.2014.11.010
DO - 10.1016/j.jamcollsurg.2014.11.010
M3 - Article
SN - 1072-7515
VL - 220
SP - 263-U57
JO - Journal of the american college of surgeons
JF - Journal of the american college of surgeons
IS - 3
T2 - United European Gastroenterology Week
Y2 - 1 October 2014
ER -