Clinic Study On The Comparison Of Laparoscopic With Open Distal Pancreatectomy

Objective:There are few studies which compared laparoscopic distal pancreatectomy (LDP) with open distal pancreatectomy (ODP). The purpose of this study was to evaluate the clinical outcomes of LDP and compare it with that of ODP in a single center.Method:A total of 122 patients, who underwent distal pancreatectomy in the Department General Surgery in Sir Run Run Show Hospital between January 2003 and January 2010, were divided into three groups-LDP(n=44), L-ODP(ODP after laparoscopic exploration) (n=9)and ODP(n=69). The clinical data of the former two groups, LDP and ODP after laparoscopic exploration, were compared with that of ODP group respectively. After excluded the cases of combined devisceration, the data of LDP group9 (LDP a) and ODP group(ODP a) were compared with each other again.Results:The age, gender, combined disease, operation history and tumor size of LDP and ODP group don't have significant difference. The mean operation time was 213.6 min in the LDP group and 221.9 min in the ODP group. The median operation bleeding loss was 225ml and 450ml, respectively. The exsufflation time, fasting time, length of hospital stay after operation and time of extubating were significantly shorter in the LDP group than in the ODP group(3d vs 4d,3d vs 4d,7d vs 13d,6d vs 9d). There is no significant difference between these two groups in the overall complication rate, pancreatic fistula rate(11.4% vs 15.9%,6.8% vs 4.3%). After excluded cases of combined devisceration, the results of comparison are the same with the above [operation time202.7±78.0min vs 200.1±64.7min, operation bleeding loss250 (30-1300)ml vs 350(100-7000)ml, exsufflation time3 (1-6)d vs 3(2-6)d, fasting time3.2±1.3d vs 3.8±1.1 d, length of hospital stay 7(4-35)d vs 11(6-55)d, time of extubating 7(2-34)d vs 8(3-55)d, overall complication rate 17.1% vs 11.9%, pancreatic fistula rate 5.7% vs 2.4%] Even in the group of L-ODP, operation time(234.4±91.7min) and operation bleeding loss [600(400-2500)ml] had no significant difference to that of ODP group.Conclutions:LDP is feasible and safe. Compared to ODP, it had the advantages of minimal injury, earlier recovery, shorter length of hospital stay.