A Comparative Analysis Of The Effect Of Laparoscopic Versus Traditional Open Distal Pancreatectomy

Object: At present,surgical treatment is the main method of the diseases of the body and tail of pancreas especially malignant ones like ductal adenocarcinoma.Traditional open distal pancreatectomy(ODP)is the most widely used and has the most exact curative effect.As a result of technological advances during the past two decades,laparoscopic pancreatic minimally invasive techniques are increasingly used in the treatment of pancreatic body and tail of benign or malignant tumors.For laparoscopic distal pancreatectomy(LDP),the feasibility of the operation,debate and study of the clinical efficacy and safety are gradually increased.Through a comparative analysis of the preoperative,intraoperative and postoperative clinical data of LDP group and ODP patients,the study aims to analyse the difference between the two surgical methods for clinical tumor treatment of pancreatic body and tail,and to evaluate the clinical value of LDP.Methods: Collecting the clinical index of 232 patients who underwent distal pancreatectomy in Affiliated Hospital of Qingdao University from Jan.2011 to Jun.2016.All the operations are performed in the department of Hepatobiliary Surgery,Department of General Surgery,Organ Transplantation Center.There are 67 patients who underwent LDP and 165 cases of ODP patients.In the first row selected LDP patients,11 cases transfer to ODP during operation(transfer rate is 12.5%),according to the distinction of final treatment,these cases are incorporated into the ODP group.Removing 29 cases who underwent combined organ resection(surgery combined with other organ resection,including stomach,colon,kidney,liver),finally,203 patients were included in the statistical analysis.Totally,there are 65 cases of LDP patients,138 cases of ODP patients.No lack of related preoperative,intraoperative,postoperative clinical indicators.Comparing the preoperative clinical index of these patients and then divide these patients into two groups according to benign or malignant diseases in order to reduce the bias caused by the different rate of malignant disease of the two groups of patients.Compare the intraoperative characteristics and post-operative recovery of the two group separately according to benign or malignant disease.SPSS 23 was used for statistical analysis to determine if the two have statistical difference to study the clinical curative effect of two operations.Results: There is no significant difference between the LDP and ODP groups in preoperative basic data in age,gender,BMI,diabetes mellitus,prior abdominal surgery,albumin,hemoglobin and so on(P>0.05).Clinical pathological results show that the malignant rate of patients in ODP is higher than that of patients in LDP(59.4% VS32.3%,P<0.05).Furthermore,the tumor volume of LDP group was higher than that of ODP group(P<0.05).Through analysing related indicators of benign and malignant disease in the two groups seperately,we can see that: for benign and malignant diseases of pancreas,coparing with ODP,patients in LDP have longer operation time and higher operation costs(P<0.05).There is no difference between the two groups in intraoperative blood transfusion(P > 0.05).For benign tumors,the amount of bleeding in LDP is significantly less than that of ODP(P < 0.05),and there is no difference in blood loss between the two groups in malignant tumors(P > 0.05).However,patients who underwent LDP have higher spleen preservation rates(P<0.05)and shorter postoperative hospital stay(P<0.05),shorter days of meal intake(P<0.05),shorter days of drainage(P<0.05).No statistical differences are found in perioperative mortality and postoperative complications(P > 0.05)like hemorrhage,incisional infection and pancreatic fistula between the two groups.Conclusion: LDP dose not increase the incidence of postoperative complications.Moreover,the rate of lymph node dissection and RO resection were the same as that of ODP.And postoperative recovery is faster in LDP.LDP is a safe and effective surgical procedure for pancreatic tumors.The clinical efficacy of LDP is better than that of ODP,and the short-term prognosis is better than that of ODP.But its long-term efficacy remains to be further studied.