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Role of laparoscopic enucleation in the treatment of pancreatic lesions: case series and case-matched analysis

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Abstract

Background

Previous studies report successful application of laparoscopic pancreatic enucleation (LPE). However, the evidence is limited to small series. This study aimed to evaluate the indications, technique and outcome of LPE at a tertiary care institution.

Methods

Between February 1998 and April 2016, 45 consecutive LPEs were performed at Oslo University Hospital—Rikshospitalet. Twenty-four (53.3 %) patients subjected to right-sided LPE (RLPE) were compared with 21 (46.7 %) patients who had undergone left-sided LPE (LLPE). A case-matched analysis (1:2) was performed to compare the outcomes following LLPE and laparoscopic distal pancreatectomy (LDP).

Results

Patient demographics, BMI, ASA score and pathological characteristics were similar between the RLPE and LLPE groups. Operative time was slightly longer for RLPE [123 (53–320) vs 102 (50–373) min, P = 0.09]. The rates of severe morbidity (≥Accordion grade III) and clinically relevant pancreatic fistula (grades B/C) were comparable, although with a trend for higher rate of complications following LLPE (16.7 vs 33.3 %; P = 0.19 and 20.8 vs 33.3 %, P = 0.34, respectively). The hospital stay was similar between RLPE and LLPE [5 (2–80) vs 7 (2–52), P = 0.49]. A case-matched analysis demonstrated shorter operating time [145 (90–350) vs 103 (50–233) min, P = 0.02], but higher readmission rate following LLPE (25 vs 3.1 %, P = 0.037).

Conclusion

LLPE seems to be associated with a higher risk of postoperative morbidity and readmission rates than LDP. RLPE is a feasible, safe approach and a reasonable alternative to pancreatoduodenectomy in selected patients with pancreatic lesions.

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Authors and Affiliations

  1. The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway

    Mushegh A. Sahakyan, Airazat M. Kazaryan, Leonid Barkhatov, Åsmund Avdem Fretland & Bjørn Edwin

  2. Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway

    Mushegh A. Sahakyan, Leonid Barkhatov, Sven-Petter Haugvik, Åsmund Avdem Fretland & Bjørn Edwin

  3. Department of Surgery No 1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia

    Mushegh A. Sahakyan

  4. Department of HPB Sugery, Oslo University Hospital - Rikshospitalet, Oslo, Norway

    Bård Ingvald Røsok, Knut Jørgen Labori & Bjørn Edwin

  5. Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway

    Airazat M. Kazaryan, Åsmund Avdem Fretland & Dejan Ignjatovic

  6. Department of Surgery, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway

    Sven-Petter Haugvik

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  1. Mushegh A. Sahakyan
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Correspondence to Mushegh A. Sahakyan.

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Mushegh A. Sahakyan, Bård Ingvald Røsok, Airazat M. Kazaryan, Leonid Barkhatov, Sven-Petter Haugvik, Åsmund Avdem Fretland, Dejan Ignjatovic, Knut-Jørgen Labori and Bjørn Edwin have no conflicts of interest or financial ties to disclose.

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Sahakyan, M.A., Røsok, B.I., Kazaryan, A.M. et al. Role of laparoscopic enucleation in the treatment of pancreatic lesions: case series and case-matched analysis. Surg Endosc 31, 2310–2316 (2017). https://doi.org/10.1007/s00464-016-5233-y

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  • DOI: https://doi.org/10.1007/s00464-016-5233-y

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