Laparoscopic Distal Pancreatectomy: Learning Curve and Experience in a Tertiary Center

Background: Although laparoscopic distal pancreatectomy (LDP) is gradually recognized as a safe and effective alternative to open distal pancreatectomy (ODP), it is not yet widely accepted. Objective: We describe our experience, with emphasis on the learning curve of LDP. Methods: Patients who underwent distal pancreatectomy (DP) between January 2011 and August 2014 were included. Operative and postoperative parameters, as well as pathology reports were evaluated. Results: Thirty-nine and 41 patients underwent LDP and ODP, respectively. The mean age and gender distribution were comparable between groups. In six patients (15.4%), a conversion to open surgery was indicated. Operating time and intraoperative blood transfusion rates were comparable between groups. One patient of the LDP group died postoperatively. Postoperative complications were comparable with similar Dindo-Clavien (DC) score. Length of stay (LOS) was shorter following LDP (8.15 +/- 4.68 versus 11.3 +/- 6.3 days, P=.014). Patients selected to have LDP had larger lesions compared to those who underwent ODP (4.59 +/- 4.23 versus 3 +/- 2.52 cm, respectively, P=.048). R0 resection rates between the groups were comparable (92.3% in LDP versus 97.5% in ODP) as well as lymph node (LN) harvest (6.4 +/- 6.4 LN in LDP versus 7.6 +/- 6.6 LN in ODP). Following the 17th patient, LDP operative time decreased by more than 35 minutes, no conversions were done, no blood transfusion was needed, and the LOS was shortened by over 2 days. Conclusions: Short learning curve, shorter LOS, and satisfactory short-term oncological outcome place LDP as an attractive alternative for selected patients requiring DP.