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Comparison of clinical outcomes and quality of life between laparoscopic and open central pancreatectomy with pancreaticojejunostomy

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Abstract

Background

The studies comparing laparoscopic and open central pancreatectomy with pancreaticojejunostomy are limited. This study aimed to compare clinical outcomes and quality of life of patients undergoing laparoscopic and open central pancreatectomy with pancreaticojejunostomy.

Methods

Between December 1997 and December 2015, patients who underwent central pancreatectomy with pancreaticojejunostomy were reviewed. Patients were divided into 2 groups as laparoscopic central pancreatectomy (LCP) and open central pancreatectomy (OCP). Data considered for comparison analysis were patient demographics, intraoperative variables, morbidity, postoperative hospital stay, mortality, pathologic findings, and quality of life (SF-36 questionnaire).

Results

Thirty-six patients (17 LCP and 19 OCP) were included in the final analysis. Baseline characteristics were similar in the 2 groups. The operating time (280.4 ± 33.6 vs. 290.5 ± 62.5 min, p = 0.455) were similar between two groups. LCP group showed significantly lower estimated blood loss (76.4 ± 70.3 vs. 390.3 ± 279.0 ml, p = 0.001), shorter first flatus time (2.4 ± 0.9 vs. 3.9 ± 1.3 days, p = 0.001), and shorter diet start time (4.1 ± 2.2 vs. 6.1 ± 2.4 days, p = 0.030). However, the postoperative hospital stay was not significantly different between two groups (15.6 ± 12.1 vs. 24.0 ± 27.5 days, p = 0.347). Postoperative outcomes, including morbidity (58.8 vs. 52.6%, p = 0.749), pancreatic fistula rates (≥grade B: 17.6 vs. 36.8%, p = 0.106), and mortality, were similar in the 2 groups. The median follow-up period was 45 months (range 4–216 months). No local recurrence or distant metastasis was detected in either group. On the follow-up survey, the total quality of life score (702.9 ± 47.9 vs. 671.8 ± 94.1), physical health score (353.9 ± 24.8 vs. 326.6 ± 67.6) and mental health score (349.0 ± 26.5 vs. 345.2 ± 34.6) were higher in the LCP group compared with the OCP group. However, these differences were not statistically significant (p > 0.05). The score in role physical (100 vs. 73.1 ± 4.8, p = 0.042) was significantly higher in LCP group, and not statistically significant in other areas (p > 0.05).

Conclusions

LCP with pancreaticojejunostomy is safe and feasible for benign or borderline malignant lesions in the pancreatic neck and proximal body. Compared to OCP, LCP is associated with lower estimated blood loss, faster recovery, and better quality of life.

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References

  1. Iacono C, Verlato G, Ruzzenente A et al (2013) Systematic review of central pancreatectomy and meta-analysis of central versus distal pancreatectomy. Br J Surg 100(7):873–885

    Article  CAS  PubMed  Google Scholar 

  2. Santangelo M, Esposito A, Tammaro V et al (2016) What indication, morbidity and mortality for central pancreatectomy in oncological surgery? A systematic review. Int J Surg 28:S172–S176

    Article  PubMed  Google Scholar 

  3. Song KB, Kim SC, Park KM et al (2015) Laparoscopic central pancreatectomy for benign or low-grade malignant lesions in the pancreatic neck and proximal body. Surg Endosc 29(4):937–946

    Article  PubMed  Google Scholar 

  4. Kang CM, Lee JH, Lee WJ (2014) Minimally invasive central pancreatectomy: current status and future directions. J Hepatobiliary Pancreat Sci 21(12):831–840

    Article  PubMed  Google Scholar 

  5. Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13

    Article  PubMed  Google Scholar 

  6. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hirono S, Tani M, Kawai M et al (2009) A central pancreatectomy for benign or low-grade malignant neoplasms. J Gastrointest Surg 13(9):1659–1665

    Article  PubMed  Google Scholar 

  8. Sullivan M, Karlsson J, Taft C (2002) SF-36 Hälsoenkät: Svensk Manual och Tolkningsguide, 2:a upplagan, 2nd edn. Swedish Manual and Interpretation Guide, Sahlgrenska University Hospital, Gothenburg

    Google Scholar 

  9. Zhang R, Xu X, Yan J et al (2013) Laparoscopic central pancreatectomy with pancreaticojejunostomy: preliminary experience with 8 cases. J Laparoendosc Adv Surg Tech A 23(11):912–918

    Article  PubMed  Google Scholar 

  10. Zhang RC, Xu XW, Zhou YC et al (2014) A rare case of mixed mucinous cystadenoma with serous cystadenoma of the pancreas treated by laparoscopic central pancreatectomy. World J Surg Oncol 12:318

    Article  PubMed  PubMed Central  Google Scholar 

  11. Baca I, Bokan I (2003) Laparoscopic segmental pancreas resection and pancreatic cystadenoma. Chirurg 74(10):961–965

    Article  CAS  PubMed  Google Scholar 

  12. Ayav A, Bresler L, Brunaud L et al (2005) Laparoscopic approach for solitary insulinoma: a multicentre study. Langenbecks Arch Surg 390(2):134–140

    Article  CAS  PubMed  Google Scholar 

  13. Orsenigo E, Baccari P, Bissolotti G et al (2006) Laparoscopic central pancreatectomy. Am J Surg 191(4):549–552

    Article  PubMed  Google Scholar 

  14. Sa Cunha A, Rault A, Beau C et al (2007) Laparoscopic central pancreatectomy: single institution experience of 6 patients. Surgery 142(3):405–409

    Article  PubMed  Google Scholar 

  15. Rotellar F, Pardo F, Montiel C et al (2008) Totally laparoscopic Roux-en-Y duct-to-mucosa pancreaticojejunostomy after middle pancreatectomy: a consecutive nine-case series at a single institution. Ann Surg 247(6):938–944

    Article  PubMed  Google Scholar 

  16. Sokolov YY, Stonogin SV, Donskoy DV et al (2009) Laparoscopic pancreatic resections for solid pseudopapillary tumor in children. Eur J Pediatr Surg 19(6):399–401

    Article  CAS  PubMed  Google Scholar 

  17. Sucandy I, Pfeifer CC, Sheldon DG (2010) Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction—an alternative surgical technique for central pancreatic mass resection. N Am J Med Sci 2(9):438–441

    Article  PubMed  PubMed Central  Google Scholar 

  18. Gumbs AA, Rodriguez-Rivera AM, Hoffman JP (2011) Minimally invasive pancreatic surgery of the entire gland: initial experience. Minerva Chir 66(4):269–280

    CAS  PubMed  Google Scholar 

  19. Gonzalez F, Mesleh MG, Lukens FJ et al (2013) Laparoscopic central pancreatectomy and pancreaticogastrostomy for the management of a proximally migrated pancreatic stent. JOP 14(3):273–276

    PubMed  Google Scholar 

  20. Machado MA, Surjan RC, Epstein MG et al (2013) Laparoscopic central pancreatectomy: a review of 51 cases. Surg Laparosc Endosc Percutaneous Tech 23(6):486–490

    Article  Google Scholar 

  21. Dokmak S, Aussilhou B, Fteriche FS et al (2014) Pure laparoscopic middle pancreatectomy: single-center experience with 13 cases. Surg Endosc 28(5):1601–1606

    Article  PubMed  Google Scholar 

  22. Chen XM, Zhang Y, Sun DL (2014) Laparoscopic central pancreatectomy for solid pseudopapillary tumors of the pancreas: our experience with ten cases. World J Surg Oncol 12:312

    Article  PubMed  PubMed Central  Google Scholar 

  23. Jiang CY, Wang W (2015) Initial experience in total laparoscopic central pancreatectomy with pancreatogastrostomy. Cell Biochem Biophys 71(2):1023–1028

    Article  CAS  PubMed  Google Scholar 

  24. Hong D, Liu Y, Peng S et al (2015) Binding pancreaticogastrostomy in laparoscopic central pancreatectomy: a novel technique in laparoscopic pancreatic surgery. Surg Endosc 29(4):937–946

    Article  Google Scholar 

  25. Senthilnathan P, Gul SI, Gurumurthy SS et al (2015) Laparoscopic central pancreatectomy: our technique and long-term results in 14 patients. J Minim Access Surg 11(3):167–171

    Article  PubMed  PubMed Central  Google Scholar 

  26. Jiao LR, Gall TM, Sodergren MH et al (2016) Laparoscopic long sleeve pancreaticogastrostomy (LPG): a novel pancreatic anastomosis following central pancreatectomy. Hepatobiliary Surg Nutr 5(3):245–248

    Article  PubMed  PubMed Central  Google Scholar 

  27. Crippa S, Bassi C, Warshaw AL et al (2007) Middle pancreatectomy: indications, short- and long-term operative outcomes. Ann Surg 246(1):69–76

    Article  PubMed  PubMed Central  Google Scholar 

  28. Rault A, SaCunha A, Klopfenstein D et al (2005) Pancreaticojejunal anastomosis is preferable to pancreaticogastrostomy after pancreaticoduodenectomy for long-term outcomes of pancreatic exocrine function. J Am Coll Surg 201(2):239–244

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by the Project Grant from Zhejiang Provincial Education Department (Grant No. Y201534423).

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Correspondence to Yi-Ping Mou.

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Zhang, RC., Zhang, B., Mou, YP. et al. Comparison of clinical outcomes and quality of life between laparoscopic and open central pancreatectomy with pancreaticojejunostomy. Surg Endosc 31, 4756–4763 (2017). https://doi.org/10.1007/s00464-017-5552-7

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  • DOI: https://doi.org/10.1007/s00464-017-5552-7

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