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Laparoscopic versus open enucleation for pancreatic neoplasms: clinical outcomes and pancreatic function analysis

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Abstract

Background

The studies comparing laparoscopic enucleation (LE) with open enucleation (OE) are limited. This study aimed to compare perioperative outcomes of patients undergoing LE and OE and to assess the pancreatic function after LE.

Methods

Between February 2001 and July 2014, patients who underwent enucleation were reviewed. Patients were divided into two groups as LE and OE. Data considered for comparison analysis were patient demographics, intraoperative variables, morbidity, postoperative hospital stay, mortality, pathologic findings, and long-term follow-up (including pancreatic function).

Results

Thirty-seven patients (15 LE and 22 OE) were included in the final analysis. Baseline characteristics were similar in the two groups. LE group showed significantly shorter operating time (118.2 ± 33.1 vs. 155.2 ± 44.3 min, p = 0.009), lower estimated blood loss (80.0 ± 71.2 vs. 195.5 ± 103.4 ml, p = 0.001), shorter first flatus time (1.8 ± 1.0 vs. 3.4 ± 1.8 days, p = 0.004), shorter diet start time (2.4 ± 1.0 vs. 4.4 ± 2.0 days, p = 0.001), shorter postoperative hospital stay (7.9 ± 3.4 vs. 11.2 ± 5.7 days, p = 0.046). Postoperative outcomes, including morbidity (40.0 vs. 45.5 %, p = 1.000), grade B/C pancreatic fistula rates (20.0 vs. 13.6 %, p = 0.874), and mortality, were similar in the two groups. The median follow-up period was 47 months (range 7–163 months). No local recurrence or distant metastasis was detected in either group. Only one patient (4.8 %) underwent OE developed new-onset diabetes, in comparison with none in the LE group. One patient (7.1 %) had weight loss and received pancreatic enzyme supplementation in the LE group, in comparison with two patients (9.5 %) in the OE group.

Conclusions

LE is a safe and feasible technique for the benign or low malignant-potential pancreatic neoplasms. Compared to OE, LE had shorter operating time, lower estimated blood loss, and faster recovery. LE could preserve the pancreatic function as the OE.

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Acknowledgments

This study was supported by Zhejiang Provincial Key Subject of Medical Science Foundation (Grant No. 11-CX-21) and the project grant from Zhejiang Provincial Education Department (Grant No. Y201432761).

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    Authors and Affiliations

    1. Department of General Surgery, Zhejiang Provincial People’s Hospital, Wenzhou Medical University, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China

      Ren-Chao Zhang, Yu-Cheng Zhou, Yi-Ping Mou, Chao-Jie Huang & Yong-Xiang Wang

    2. School of Medicine, Zhejiang University, Hangzhou, 310029, Zhejiang Province, China

      Wei-Wei Jin

    3. Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang Province, China

      Jia-Fei Yan

    4. Wenzhou Medical University, Wenzhou, 325035, Zhejiang Province, China

      Yi Liao

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    1. Ren-Chao Zhang
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    Ren-Chao Zhang, Yu-Cheng Zhou, Yi-Ping Mou, Chao-Jie Huang, Wei-Wei Jin, Jia-Fei Yan, Yong-Xiang Wang, and Yi Liao have no conflict of interest or financial ties to disclose.

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    Ren-Chao Zhang and Yu-Cheng Zhou have contributed equally to this work.

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    Zhang, RC., Zhou, YC., Mou, YP. et al. Laparoscopic versus open enucleation for pancreatic neoplasms: clinical outcomes and pancreatic function analysis. Surg Endosc 30, 2657–2665 (2016). https://doi.org/10.1007/s00464-015-4538-6

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    • DOI: https://doi.org/10.1007/s00464-015-4538-6

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