Propensity score-matched comparison of oncological outcomes between laparoscopic and open distal pancreatic resection

BackgroundSelected studies have reported improved outcomes in laparoscopic compared with open distal pancreatic resection. Concerns regarding failure to achieve proper oncological resection and compromised long-term outcomes remain. This study investigated whether postoperative outcomes and long-term survival after laparoscopic distal pancreatectomy are comparable to those after an open procedure. MethodsThis retrospective case-control study included patients who underwent distal pancreatectomy for resectable pancreatic adenocarcinoma between 2010 and 2013, identified from the National Cancer Database. Propensity score nearest-neighbour 1 : 1 matching was performed between patients undergoing laparoscopic or open distal pancreatectomy based on all relevant co-variables. The primary outcome was overall survival. ResultsOf 1947 eligible patients, 605 (311 per cent) underwent laparoscopic distal pancreatectomy. After propensity score matching, two well balanced groups of 563 patients each were analysed. There was no difference in overall survival at 3years after laparoscopic versus open distal pancreatectomy (416 versus 360 per cent; hazard ratio 093, 95 per cent c.i. 077 to 112; P=0457). The overall conversion rate was 273 per cent (165 of 605). Patients who underwent laparoscopic distal pancreatectomy had outcomes comparable to those of patients who had an open procedure with regard to median time to chemotherapy (50 versus 50days; P=0342), median number of nodes examined (12 versus 12; P=0759); 30-day mortality (12 versus 09 per cent; P=0562); 90-day mortality (28 versus 37 per cent; P=0403), 30-day readmission rate (96 versus 92 per cent; P=0838) and positive margin rate (149 versus 185 per cent; P=0110). However, median duration of hospital stay was shorter in the laparoscopic group (6 versus 7days; P<0001). ConclusionLaparoscopic distal pancreatectomy is an acceptable alternative to open distal pancreatectomy with no detriment to survival. No difference in survival