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Laparoscopic versus open distal pancreatectomy—a propensity score-matched analysis from the German StuDoQ|Pancreas registry

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to assess intraoperative, postoperative, and oncologic outcome in patients undergoing laparoscopic distal pancreatectomy (LDP) versus open distal pancreatectomy (ODP) for benign and malignant lesions of the pancreas.

Methods

Data from patients undergoing distal pancreatic resection were extracted from the StuDoQ|Pancreas registry of the German Society for General and Visceral Surgery. After propensity score case matching, groups of LDP and ODP were compared regarding demography, comorbidities, operative details, histopathology, and perioperative outcome.

Results

At the time of data extraction, the StuDoQ|Pancreas registry included over 3000 pancreatic resections from over 50 surgical departments in Germany. Data from 353 patients undergoing ODP (n = 254) or LDP (n = 99) from September 2013 to February 2016 at 29 institutions were included in the analysis. Baseline data showed a strong selection bias in LDP patients, which disappeared after 1:1 propensity score matching. A comparison of the matched groups disclosed a significantly longer operation time, higher rate of spleen preservation, more grade A pancreatic fistula, shorter hospital stay, and increased readmissions for LDP. In the small group of patients operated for pancreatic cancer, a lower lymph node yield with a lower lymph node ratio was apparent in LDP.

Conclusions

LDP needed more time but potential advantages include increased spleen preservation and shorter hospital stay, as well as a trend for less transfusion, ventilation, and mortality. LDP for pancreatic cancer was performed rarely and will need critical evaluation in the future. Data from a prospective randomized registry trial is needed to confirm these results.

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Acknowledgements

This study has been conducted using the StuDoQ|Pancreas registry provided by the Study, Documentation, and Quality Center (Studien, Dokumentations- und Qualitätszentrum, StuDoQ) of the German Society for General and Visceral Surgery (Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, DGAV) with the ID StuDoQ|Pankreas-0001.

Members of the StuDoQ|Pancreas study group who contributed to this study, in order of enrolled cases:

Prof. Dr. Thomas Kraus, Allgemeine, Viszeral und Minimalinvasive Chirurgie, Nordwestkrankenhaus Frankfurt, Frankfurt, Germany

Prof. Dr. Michael Ghadimi, Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Göttingen, Germany

Prof. Dr. Carsten Gutt, Allgemein-, Visceral-, Gefäß- und Thoraxchirurgie, Klinikum Memmingen, Memmingen, Germany

Prof. Dr. Thomas Manger, Abteilung für Allgemeine-, Viszeral- und Kinderchirurgie, SRH Waldklinikum Gera, Gera, Germany

Prof. Dr. Jens Werner, Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Klinikum der LMU München, Klinikum Großhadern, München, Germany

Prof. Dr. Helmut Witzigmann, Allgemein- und Viszeralchirurgie, Städtisches Klinikum Dresden Friedrichstadt, Dresden, Germany

Prof. Dr. Christoph-Thomas Germer, Klinik & Poliklinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinik Würzburg, Würzburg, Germany

Prof. Dr. Jörg-Peter Ritz, Klinik für Allgemein- und Viszeralchirurgie, Helios Kliniken Schwerin, Schwerin, Germany

Dr. Ute Tröbs, Allgemein- und Viszeralchirurgie, Kreiskrankenhaus Delitzsch, Delitzsch, Germany

Prof. Dr. Winfried Padberg, Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen Marburg Standort Gießen, Giessen, Germany

Prof. Dr. Matthias Glanemann, Klinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Homburg an der Saar, Germany

Prof. Dr. Jörg C. Kalff, Abteilung für Viszerale/kolorektale Chirurgie und Proktologie, Universitätsklinikum Bonn, Bonn, Germany

Prof. Dr. Anton J. Kroesen, Klinik für Allgemein-, Viszeral- und Unfallchirurgie, Krankenhaus Porz am Rhein, Köln, Germany

Prof. Dr. Pompiliu Piso, Chirurgie I, Barmherzige Brüder Regensburg, Regensburg, Germany

Prof. Dr. Stefan Post, Chirurgische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany

Prof. Dr. Hans-Bernd Reith, Allgemein- und Viszeralchirurgie, Agaplesion Diakoniekliniken Kassel, Kassel, Germany

Prof. Dr. Norbert Senninger, Klinik und Poliklinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Münster, Münster, Germany

Prof. Dr. Ernst Klar, Allgemeine-, Thorax-, Gefäß- und Transplantationschirurgie, Universitätsmedizin Rostock, Rostock, Germany

Dr. Franz-Josef Schumacher, Klinik für Allgemein- und Viszeralchirurgie, Katholische Kliniken Oberhausen, Oberhausen, Germany

Prof. Dr. Albrecht Stier, Klinik für Allgemein- und Viszeralchirurgie, Helios-Klinik Erfurt, Erfurt, Germany

Prof. Dr. Elke Wagler, Allgemein-, Visceral- und Onkochirurgie, Pleißental-Klinik GmbH, Werdau, Germany

Author information

Authors and Affiliations

  1. Clinic for Surgery, University Clinic Schleswig-Holstein, UKSH Campus Lübeck, 23538, Lübeck, Germany

    Ulrich Friedrich Wellner, Hryhoriy Lapshyn & Tobias Keck

  2. Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Marburg, Germany

    Detlef K. Bartsch & Ioannis Mintziras

  3. Clinic for General and Visceral Surgery, University Medical Center Freiburg, Freiburg, Germany

    Ulrich Theodor Hopt & Uwe Wittel

  4. Department of General, Visceral and Vascular Surgery, Evangelical Hospital of Düsseldorf, Düsseldorf, Germany

    Hans-Jörg Krämling & Hubert Preissinger-Heinzel

  5. Department of General, Visceral and Transplantation Surgery,, Clinic Augsburg, Augsburg, Germany

    Matthias Anthuber & Bernd Geissler

  6. Department of General, Visceral, Thoracic, and Transplantation Surgery, Katharinenhospital, Clinic Stuttgart, Stuttgart, Germany

    Jörg Köninger & Katharina Feilhauer

  7. Department of General and Visceral Surgery, Central Clinic Bad Berka, Bad Berka, Germany

    Merten Hommann & Luisa Peter

  8. Department of General and Visceral Surgery, Endocrine Surgery and Coloproctology,, Clinic Neuperlach, Munich, Germany

    Natascha C. Nüssler & Thomas Klier

  9. Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany

    Ulrich Mansmann

  10. German Cancer Consortium (DKTK), Heidelberg, Germany

    Ulrich Mansmann

Authors
  1. Ulrich Friedrich Wellner
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  2. Hryhoriy Lapshyn
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  3. Detlef K. Bartsch
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  4. Ioannis Mintziras
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  5. Ulrich Theodor Hopt
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  6. Uwe Wittel
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  7. Hans-Jörg Krämling
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  8. Hubert Preissinger-Heinzel
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  9. Matthias Anthuber
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  10. Bernd Geissler
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  11. Jörg Köninger
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  12. Katharina Feilhauer
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  13. Merten Hommann
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  14. Luisa Peter
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  15. Natascha C. Nüssler
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  16. Thomas Klier
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  17. Ulrich Mansmann
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  18. Tobias Keck
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Consortia

The StuDoQ Pancreas study group and members of StuDoQ|Pancreas registry of the German Society for General and Visceral Surgery (DGAV)

Corresponding author

Correspondence to Tobias Keck.

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Conflict of interest

The authors are members of the German Society for General and Visceral Surgery (DGAV).

Ethical approval

For this type of study, a formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Wellner, U.F., Lapshyn, H., Bartsch, D.K. et al. Laparoscopic versus open distal pancreatectomy—a propensity score-matched analysis from the German StuDoQ|Pancreas registry. Int J Colorectal Dis 32, 273–280 (2017). https://doi.org/10.1007/s00384-016-2693-4

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  • DOI: https://doi.org/10.1007/s00384-016-2693-4

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