Original Article

J Minim Invasive Surg 2012; 15(4): 83-92

Published online December 15, 2012

https://doi.org/10.7602/jmis.2012.15.4.83

© The Korean Society of Endo-Laparoscopic & Robotic Surgery

췌장중앙절제에 있어서 복강경 수술과 개복 수술의 비교: 단일기관 95예의 경험

강민창ㆍ김송철ㆍ송기병ㆍ박광민ㆍ이재훈ㆍ황지웅ㆍ김영환ㆍ남정수ㆍ윤종희ㆍ이영주

울산대학교 의과대학 서울아산병원 간담췌외과

Laparoscopic Versus Open Central Pancreatectomy: Single-institution Comparative Study

Min Chang Kang, M.D., Song Cheol Kim, M.D., Ki Byung Song, M.D., Kwang-Min Park, M.D., Jae Hoon Lee, M.D., Ji Wong Hwang, M.D., Young Hwan Kim, M.D., Jeong Su Nam, M.D., Jong Hee Yoon, M.D., Young-Joo Lee, M.D.

Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Purpose: Despite recent advances in laparoscopic pancreatic surgery, few studies have compared laparoscopic central pancreatectomy (LCP) with open central pancreatectomy (OCP). The aim of this study was to compare clinical outcomes between LCP and OCP as a single institutional study.
Methods: During the study period (From January, 1998 to December, 2010), we performed central pancreatectomy in 95 cases. Among them, 26 cases of totally LCP and 55 cases of OCP were compared retrospectively.
Results: Benign pancreatic neoplasm was the main indication. The mean operation time for the LCP group (350.2 min) was longer than that for the OCP group (283.4 min). And there was no significant difference in mean actual blood loss (477 ml versus 714 ml, p=0.083) between the LCP and OCP groups. Return to a normal bowel movement and resumption of a liquid diet were achieved 5.5±2.6 days after the operation in the LCP group and 6.6±2.0 days after the operation in the OCP group (p=0.039). The mean duration of postoperative hospital stay was 13.8 days for the LCP group, which was significantly shorter than the 22.5 days for the OCP group (p=0.015). The overall complication rate was 42.3% (11 cases) in the LCP group and 45.5% (25 cases) in the OCP group (p=0.790).
Conclusion: Use of LCP for benign or low grade malignant lesions of the pancreatic neck portion is feasible and safe. Compared to the open method, the laparoscopic approach to central pancreatectomy appears to provide advantages of early resumption of a normal diet and reduction of postoperative hospital stay without further complications.

Keywords Laparoscopy, Pancreatic fistula, Pancreatectomy

  1. Park H, Nah YW, Nam CW, Bang SJ. Comparison of laparoscopic and open distal pancreatectomy with focus on the development of postope rative pancreatic fistula. J Korean Soc Endosc Laparosc Surg 2011;14:42-50.
  2. Aly MY, Tsutsumi K, Nakamura M, et al. Comparative study of laparoscopic and open distal pancreatectomy. J Laparoendosc Adv Surg Tech A 2010;20:435-440.
    Pubmed CrossRef
  3. Butturini G, Partelli S, Crippa S, et al. Perioperative and long-term results after left pancreatectomy: a single-ins titution, non-randomized, comparative study between open and laparoscopic approach. Surg Endosc 2011;25:2871-2878.
    Pubmed CrossRef
  4. Vijan SS, Ahmed KA, Harmsen WS, et al. Laparoscopic vs open distal pancreatectomy: a single-institution comparative study. Arch Surg 2010;145:616-621.
    Pubmed CrossRef
  5. Song KB, Kim SC, Park JB, et al. Single-center experience of laparoscopic left pancreatic resection in 359 consecutive patients: changing the surgical paradigm of left pancreatic resection. Surg Endosc 2011;25:3364-3372.
    Pubmed CrossRef
  6. Kahl S, Malfertheiner P. Exocrine and endocrine pancreatic insufficiency after pancreatic surgery. Best Pract Res Clin Gastroenterol 2004;18:947-955.
    CrossRef
  7. Warshaw AL, Rattner DW, Fernandez-del Castillo C, Z'Graggen K. Middle segment pancreatectomy: a novel technique for conserving pancreatic tissue. Arch Surg 1998;133:327-331.
    Pubmed CrossRef
  8. Dagradi A, Serio G. Pancreatectomia intermedia. In Encicloped ia medica italiana. Pancreas 1984;11:850-851.
  9. DiNorcia J, Ahmed L, Lee MK, et al. Better preservation of endocrine function after central versus distal pancreatectomy for mid-gland lesions. Surgery 2010;148:1247-1254.
    Pubmed CrossRef
  10. Crippa S, Bassi C, Warshaw AL, et al. Middle pancreatectomy:indications, short- and long-term operative outcomes. Ann Surg 2007;246:69-76.
    Pubmed KoreaMed CrossRef
  11. Roggin KK, Rudloff U, Blumgart LH, Brennan MF. Central pancreatectomy revisit ed. Journal of gastrointestinal surgery. J Gastrointest Surg 2006;10:804-812.
    Pubmed CrossRef
  12. Christein JD, Smoot RL, Farnell MB. Central pancreatectomy:a technique for the resection of pancreatic neck lesions. Arch Surg 2006;141:293-299.
    Pubmed CrossRef
  13. Sauvanet A, Partensky C, Sastre B, et al. Medial pancreatect omy:a multi-institutional retrospective study of 53 patients by the French Pancreas Club. Surgery 2002;132:836-843.
    Pubmed CrossRef
  14. Fernandez-del Castillo C, Targarona J, Thayer SP, Rattner DW , Brugge WR, Warshaw AL. Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg 2003;138:427-423.
    Pubmed KoreaMed CrossRef
  15. Zaheer A, Pokharel SS, Wolfgang C, Fishman EK, Horton KM. Incidentally detected cystic lesions of the pancreas on CT: review of literature and management suggestions. Abdom Imaging 2012 [Epub ahead of print].
  16. Feldman JM, Roth JV, Bjoraker DG. Maximum blood savings by acute normovolemic hemodilution. Anesth Analg 1995;80:108-113.
    Pubmed
  17. McCullough TC, Roth JV, Ginsberg PC, Harkaway RC. Estimated blood loss underestimates calculated blood loss durin g radical retropubic prostatectomy. Urol Int 2004;72:13-16.
    Pubmed CrossRef
  18. Dindo D, Demartines N, Cl avien P-A. Classification of surgical complications. Ann Surg 2004;240:205-213.
    Pubmed KoreaMed CrossRef
  19. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancr eatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8-13.
    Pubmed CrossRef
  20. Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 1994;8:408-410.
    Pubmed CrossRef
  21. Cuschieri A, Jakimowicz JJ, van Spreeuwel J. Laparoscopic di stal 70% pancreatectomy and splenectomy for chronic pancreatitis. Ann Surg 1996;223:280-285.
    Pubmed KoreaMed CrossRef
  22. Zhou J, Dong M, Kong F, Li Y, Tian Y. Central pancreatectomy for benign tumors of the neck and body of the pancreas: report of eight cases. J Surg Oncol 2009;100:273-276.
    Pubmed CrossRef
  23. Kim SC, Park KT, Hwang JW, et al. Comparative analysis of clinical outcomes for laparosc opic distal pancreatic resection and open distal pancreatic resection at a single institution. Surg Endosc 2008;22:2261-2268.
    Pubmed CrossRef
  24. Orsenigo E, Baccari P, Bissolotti G, Staudacher C. Laparosco pic central pancreatectomy. Am J Surg 2006;191:549-552.
    Pubmed CrossRef
  25. Rotellar F, Pardo F, Montiel C, et al. Totally laparoscopic Roux-en-Y duct-to-mucosa pancreaticojejunostomy after middle pancreatectomy: a consecutive nine-case series at a single institution. Ann Surg 2008;247:938-944.
    Pubmed CrossRef
  26. Sa Cunha A, Rault A, Beau C, Collet D, Masson B. Laparoscopi c central pancreatectomy: single institution experience of 6 pati ents. Surgery 2007;142:405-409.
    Pubmed CrossRef
  27. Venara A, de Franco V, Mucci S, et al. Central pancreatectom y:comparison of results according to the type of anastomosis. J Visc Surg 2012;149:e153-158.
    Pubmed CrossRef
  28. Bassi C, Falconi M, Molinari E, et al. Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Ann Surg 2005;242:767-771.
    Pubmed KoreaMed CrossRef
  29. Wayne M, Neragi-Miandoab S, Kasmin F, Brown W, Pahuja A, Cooperman AM. Central pancreatectomy without anastomosis. World J Surg Oncol 2009;7:67.
    Pubmed KoreaMed CrossRef
  30. Fromm D, Schwarz K. Ligation of the pancreatic duct during difficult operative circumstances. J Am Coll Surg 2003;197:943-948.
    CrossRef

Article

Original Article

J Minim Invasive Surg 2012; 15(4): 83-92

Published online December 15, 2012 https://doi.org/10.7602/jmis.2012.15.4.83

Copyright © The Korean Society of Endo-Laparoscopic & Robotic Surgery.

췌장중앙절제에 있어서 복강경 수술과 개복 수술의 비교: 단일기관 95예의 경험

강민창ㆍ김송철ㆍ송기병ㆍ박광민ㆍ이재훈ㆍ황지웅ㆍ김영환ㆍ남정수ㆍ윤종희ㆍ이영주

울산대학교 의과대학 서울아산병원 간담췌외과

Laparoscopic Versus Open Central Pancreatectomy: Single-institution Comparative Study

Min Chang Kang, M.D., Song Cheol Kim, M.D., Ki Byung Song, M.D., Kwang-Min Park, M.D., Jae Hoon Lee, M.D., Ji Wong Hwang, M.D., Young Hwan Kim, M.D., Jeong Su Nam, M.D., Jong Hee Yoon, M.D., Young-Joo Lee, M.D.

Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose: Despite recent advances in laparoscopic pancreatic surgery, few studies have compared laparoscopic central pancreatectomy (LCP) with open central pancreatectomy (OCP). The aim of this study was to compare clinical outcomes between LCP and OCP as a single institutional study.
Methods: During the study period (From January, 1998 to December, 2010), we performed central pancreatectomy in 95 cases. Among them, 26 cases of totally LCP and 55 cases of OCP were compared retrospectively.
Results: Benign pancreatic neoplasm was the main indication. The mean operation time for the LCP group (350.2 min) was longer than that for the OCP group (283.4 min). And there was no significant difference in mean actual blood loss (477 ml versus 714 ml, p=0.083) between the LCP and OCP groups. Return to a normal bowel movement and resumption of a liquid diet were achieved 5.5±2.6 days after the operation in the LCP group and 6.6±2.0 days after the operation in the OCP group (p=0.039). The mean duration of postoperative hospital stay was 13.8 days for the LCP group, which was significantly shorter than the 22.5 days for the OCP group (p=0.015). The overall complication rate was 42.3% (11 cases) in the LCP group and 45.5% (25 cases) in the OCP group (p=0.790).
Conclusion: Use of LCP for benign or low grade malignant lesions of the pancreatic neck portion is feasible and safe. Compared to the open method, the laparoscopic approach to central pancreatectomy appears to provide advantages of early resumption of a normal diet and reduction of postoperative hospital stay without further complications.

Keywords: Laparoscopy, Pancreatic fistula, Pancreatectomy

References

  1. Park H, Nah YW, Nam CW, Bang SJ. Comparison of laparoscopic and open distal pancreatectomy with focus on the development of postope rative pancreatic fistula. J Korean Soc Endosc Laparosc Surg 2011;14:42-50.
  2. Aly MY, Tsutsumi K, Nakamura M, et al. Comparative study of laparoscopic and open distal pancreatectomy. J Laparoendosc Adv Surg Tech A 2010;20:435-440.
    Pubmed CrossRef
  3. Butturini G, Partelli S, Crippa S, et al. Perioperative and long-term results after left pancreatectomy: a single-ins titution, non-randomized, comparative study between open and laparoscopic approach. Surg Endosc 2011;25:2871-2878.
    Pubmed CrossRef
  4. Vijan SS, Ahmed KA, Harmsen WS, et al. Laparoscopic vs open distal pancreatectomy: a single-institution comparative study. Arch Surg 2010;145:616-621.
    Pubmed CrossRef
  5. Song KB, Kim SC, Park JB, et al. Single-center experience of laparoscopic left pancreatic resection in 359 consecutive patients: changing the surgical paradigm of left pancreatic resection. Surg Endosc 2011;25:3364-3372.
    Pubmed CrossRef
  6. Kahl S, Malfertheiner P. Exocrine and endocrine pancreatic insufficiency after pancreatic surgery. Best Pract Res Clin Gastroenterol 2004;18:947-955.
    CrossRef
  7. Warshaw AL, Rattner DW, Fernandez-del Castillo C, Z'Graggen K. Middle segment pancreatectomy: a novel technique for conserving pancreatic tissue. Arch Surg 1998;133:327-331.
    Pubmed CrossRef
  8. Dagradi A, Serio G. Pancreatectomia intermedia. In Encicloped ia medica italiana. Pancreas 1984;11:850-851.
  9. DiNorcia J, Ahmed L, Lee MK, et al. Better preservation of endocrine function after central versus distal pancreatectomy for mid-gland lesions. Surgery 2010;148:1247-1254.
    Pubmed CrossRef
  10. Crippa S, Bassi C, Warshaw AL, et al. Middle pancreatectomy:indications, short- and long-term operative outcomes. Ann Surg 2007;246:69-76.
    Pubmed KoreaMed CrossRef
  11. Roggin KK, Rudloff U, Blumgart LH, Brennan MF. Central pancreatectomy revisit ed. Journal of gastrointestinal surgery. J Gastrointest Surg 2006;10:804-812.
    Pubmed CrossRef
  12. Christein JD, Smoot RL, Farnell MB. Central pancreatectomy:a technique for the resection of pancreatic neck lesions. Arch Surg 2006;141:293-299.
    Pubmed CrossRef
  13. Sauvanet A, Partensky C, Sastre B, et al. Medial pancreatect omy:a multi-institutional retrospective study of 53 patients by the French Pancreas Club. Surgery 2002;132:836-843.
    Pubmed CrossRef
  14. Fernandez-del Castillo C, Targarona J, Thayer SP, Rattner DW , Brugge WR, Warshaw AL. Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg 2003;138:427-423.
    Pubmed KoreaMed CrossRef
  15. Zaheer A, Pokharel SS, Wolfgang C, Fishman EK, Horton KM. Incidentally detected cystic lesions of the pancreas on CT: review of literature and management suggestions. Abdom Imaging 2012 [Epub ahead of print].
  16. Feldman JM, Roth JV, Bjoraker DG. Maximum blood savings by acute normovolemic hemodilution. Anesth Analg 1995;80:108-113.
    Pubmed
  17. McCullough TC, Roth JV, Ginsberg PC, Harkaway RC. Estimated blood loss underestimates calculated blood loss durin g radical retropubic prostatectomy. Urol Int 2004;72:13-16.
    Pubmed CrossRef
  18. Dindo D, Demartines N, Cl avien P-A. Classification of surgical complications. Ann Surg 2004;240:205-213.
    Pubmed KoreaMed CrossRef
  19. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancr eatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8-13.
    Pubmed CrossRef
  20. Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 1994;8:408-410.
    Pubmed CrossRef
  21. Cuschieri A, Jakimowicz JJ, van Spreeuwel J. Laparoscopic di stal 70% pancreatectomy and splenectomy for chronic pancreatitis. Ann Surg 1996;223:280-285.
    Pubmed KoreaMed CrossRef
  22. Zhou J, Dong M, Kong F, Li Y, Tian Y. Central pancreatectomy for benign tumors of the neck and body of the pancreas: report of eight cases. J Surg Oncol 2009;100:273-276.
    Pubmed CrossRef
  23. Kim SC, Park KT, Hwang JW, et al. Comparative analysis of clinical outcomes for laparosc opic distal pancreatic resection and open distal pancreatic resection at a single institution. Surg Endosc 2008;22:2261-2268.
    Pubmed CrossRef
  24. Orsenigo E, Baccari P, Bissolotti G, Staudacher C. Laparosco pic central pancreatectomy. Am J Surg 2006;191:549-552.
    Pubmed CrossRef
  25. Rotellar F, Pardo F, Montiel C, et al. Totally laparoscopic Roux-en-Y duct-to-mucosa pancreaticojejunostomy after middle pancreatectomy: a consecutive nine-case series at a single institution. Ann Surg 2008;247:938-944.
    Pubmed CrossRef
  26. Sa Cunha A, Rault A, Beau C, Collet D, Masson B. Laparoscopi c central pancreatectomy: single institution experience of 6 pati ents. Surgery 2007;142:405-409.
    Pubmed CrossRef
  27. Venara A, de Franco V, Mucci S, et al. Central pancreatectom y:comparison of results according to the type of anastomosis. J Visc Surg 2012;149:e153-158.
    Pubmed CrossRef
  28. Bassi C, Falconi M, Molinari E, et al. Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Ann Surg 2005;242:767-771.
    Pubmed KoreaMed CrossRef
  29. Wayne M, Neragi-Miandoab S, Kasmin F, Brown W, Pahuja A, Cooperman AM. Central pancreatectomy without anastomosis. World J Surg Oncol 2009;7:67.
    Pubmed KoreaMed CrossRef
  30. Fromm D, Schwarz K. Ligation of the pancreatic duct during difficult operative circumstances. J Am Coll Surg 2003;197:943-948.
    CrossRef

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