ASA: Laparoscopic Surgery Gets Good Grades for Pancreatectomy

By Charles Bankhead
NEW YORK, 26 april 2008 -- For patients with cancer confined to the pancreatic body or tail, laparoscopic left pancreatectomy leads to less morbidity, lower complication rates, and shorter hospitalization, according to data reported here. Compared with an average nine days in the hospital after open surgery, laparoscopic patients were two-thirds less likely to stay for more than seven days, David A. Kooby, M.D., of Emory University in Atlanta, said at the American Surgical Association meeting."If we can offer someone a more cosmetically acceptable result, do it safely, and potentially get them out of the hospital faster -- that's not a bad thing," Dr. Kooby said in an interview.
Laparoscopic left pancreatectomy has increased in recent years, but its performance compared with open pancreatectomy has not been well studied. Dr. Kooby presented findings from an analysis of eight centers' combined experience with the laparoscopic procedure from 2002 through 2006.
The analysis included 159 patients who had laparoscopic procedures and 508 patients who had open surgery. Indications for surgery were solid lesion (307, 46%), cystic lesion (295, 44%), and pancreatitis (65, 10%). Twenty laparoscopic procedures were converted to open surgery.
Dr. Kooby said 200 patients in the open-surgery group were matched with 142 patients in the laparoscopic group by age, American Society of Anesthesiologists surgical risk category, resected pancreas length, tumor size, and diagnosis. The groups did not differ significantly in positive margins (8% versus 7% with open surgery), operative time (216 versus 230 minutes), or leakage (18% versus 11%).
Compared with open surgery, laparoscopic left pancreatectomy significantly significantly reduced:
Blood loss, 357 versus 588 cc, P<0.01
Complication rate, 40% versus 57%, P<0.01
Hospital length of stay, 5.9 versus 9.0 days, P<0.01
In multivariate analysis, laparascopic left pancreatectomy remained a significant predictor of a shorter hospital stay (OR 0.33, P<0.01).
The biggest difference in postop complications involved wound infection. Dr. Kooby said the rate of wound infection in the laparoscopic group was about a third of that in open-surgery patients.
Ordinarily, a randomized clinical trial would be warranted to compare two treatments, but Dr. Kooby said such a trial is unlikely in this case. Of the more than 30,000 patients with newly diagnosed pancreatic cancer each year, about a third go to surgery. Of those, 10% to 15% have cancer limited to the tail or body of the pancreas, but two thirds would not be candidates for laparoscopic surgery because the cancer has grown into surrounding tissues.
"You're talking about 500 or 750 cases a year," said Dr. Kooby.
"We have enough data to say that, in the right hands and with the right indications, [laparoscopic surgery] is not only an acceptable approach but it may actually be the preferred approach," said Dr. Kooby.
Dr. Kooby reported no disclosures.
Primary source: American Surgical Association MeetingSource reference:Kooby DA, et al "Multicenter analysis of 667 left pancreatectomies: should the laparoscopic approach become standard?" ASA Meeting 2008; Abstract 15.