Ann Surg. 2022 Nov 18. doi: 10.1097/SLA.0000000000005758. Online ahead of print.
OBJECTIVE: This study aimed to compare the short-term outcomes between laparoscopic and open distal pancreatectomy for lesions of the distal pancreas from a real-world database.
SUMMARY BACKGROUND DATA: Reports on the benefits of laparoscopic distal pancreatectomy include two randomized controlled trials; however, large-scale, real-world data are scarce.
METHODS: We analyzed the data of patients undergoing laparoscopic or open distal pancreatectomy for benign or malignant pancreatic tumors from April 2008 to May 2020 from a Japanese nationwide inpatient database. We performed propensity score analyses to compare the in-hospital mortality, morbidity, readmission rate, reoperation rate, length of postoperative stay, and medical cost between the two groups.
RESULTS: From 5,502 eligible patients, we created a pseudo-population of patients undergoing laparoscopic and open distal pancreatectomy using inverse probability of treatment weighting. Laparoscopic distal pancreatectomy was associated with lower in-hospital mortality during the period of admission (0.0% vs. 0.7%, P<0.001) and within 30 days (0.0% vs. 0.2%, P=0.001), incidence of reoperation during the period of admission (0.7% vs. 1.7%, P=0.018), post-pancreatectomy hemorrhage (0.4% vs. 2.0%, P<0.001), ileus (1.1% vs. 2.8%, P=0.007), and shorter postoperative length of stay (17 vs. 20 d, P<0.001).
CONCLUSIONS: The propensity score analysis revealed that laparoscopic distal pancreatectomy was associated with better outcomes than open surgery in terms of in-hospital mortality, reoperation rate, postoperative length of stay, and incidence of postoperative complications such as post pancreatectomy hemorrhage and ileus.