Multicentre observational cohort study of implementation and outcomes of laparoscopic distal pancreatectomy

Background Laparoscopic distal pancreatectomy (LDP) is increasingly being performed as an alternative to open surgery. Whether the implementation and corresponding learning curve of LDP have an impact on patient outcome is unknown. The aim was to investigate the temporal trends in practice across UK centres. Methods This was a retrospective multicentre observational cohort study of LDP in 11 tertiary referral centres in the UK between 2006 and 2016. The learning curve was analysed by pooling data for the first 15 consecutive patients who had LDP and examining trends in surgical outcomes in subsequent patients. Results In total, 570 patients underwent LDP, whereas 888 underwent open resection. For LDP the median duration of operation was 240 min, with 200 ml blood loss. The conversion rate was 12 center dot 1 per cent. Neuroendocrine tumours (26 center dot 7 per cent) and mucinous cystic neoplasms (19 center dot 7 per cent) were commonest indications. The proportion of LDPs increased from 24 center dot 4 per cent in 2006-2009 (P1) to 46 center dot 0 per cent in 2014-2016 (P3) (P < 0 center dot 001). LDP was increasingly performed for patients aged 70 years or more (16 per cent in P1 versus 34 center dot 4 per cent in P3; P = 0 center dot 002), pancreatic ductal adenocarcinoma (6 versus 19 center dot 1 per cent; P = 0 center dot 005) and advanced malignant tumours (27 versus 52 per cent; P = 0 center dot 016). With increasing experience, there was a trend for a decrease in blood transfusion rate (14 center dot 1 per cent for procedures 1-15 to 3 center dot 5 per cent for procedures 46-75; P = 0 center dot 008), ICU admissions (32 center dot 7 to 19 center dot 2 per cent; P = 0 center dot 021) and median duration of hospital stay (7 (i.q.r. 5-9) to 6 (4-7) days; P = 0 center dot 002). After 30 procedures, a decrease was noted in rates of both overall morbidity (57 center dot 7 versus 42 center dot 2 per cent for procedures 16-30 versus 46-75 respectively; P = 0 center dot 009) and severe morbidity (18 center dot 8 versus 9 center dot 7 per cent; P = 0 center dot 031). Conclusion LDP has increased as a treatment option for lesions of the distal pancreas as indications for the procedure have expanded. Perioperative outcomes improved with the number of procedures performed.