A Multicenter Analysis of Distal Pancreatectomy for Adenocarcinoma

Is Laparoscopic Resection Appropriate?

David A. Kooby, William G. Hawkins, C. Max Schmidt, Sharon M. Weber, David J. Bentrem, Theresa W. Gillespie, Johnita Byrd Sellers, Nipun B. Merchant, Charles R. Scoggins, Robert C G Martin, Hong Jin Kim, Syed Ahmad, Clifford S. Cho, Alexander A. Parikh, Carrie K. Chu, Nicholas Hamilton, Courtney J. Doyle, Scott Pinchot, Amanda Hayman, Rebecca McClaine & 4 others Attila Nakeeb, Charles A. Staley, Kelly M. McMasters, Keith D. Lillemoe

Research output: Contribution to journalArticle

235 Citations (Scopus)

Abstract

Background: As compared with open distal pancreatectomy (ODP), laparoscopic distal pancreatectomy (LDP) affords improved perioperative outcomes. The role of LDP for patients with pancreatic ductal adenocarcinoma (PDAC) is not defined. Study Design: Records from patients undergoing distal pancreatectomy (DP) for PDAC from 2000 to 2008 from 9 academic medical centers were reviewed. Short-term (node harvest and margin status) and long-term (survival) cancer outcomes were assessed. A 3:1 matched analysis was performed for ODP and LDP cases using age, American Society of Anesthesiologists (ASA) class, and tumor size. Results: There were 212 patients who underwent DP for PDAC; 23 (11%) of these were approached laparoscopically. For all 212 patients, 56 (26%) had positive margins. The mean number of nodes (± SD) examined was 12.6 ±8.4 and 114 patients (54%) had at least 1 positive node. Median overall survival was 16 months. In the matched analysis there were no significant differences in positive margin rates, number of nodes examined, number of patients with at least 1 positive node, or overall survival. Logistic regression for all 212 patients demonstrated that advanced age, larger tumors, positive margins, and node positive disease were independently associated with worse survival; however, method of resection (ODP vs. LDP) was not. Hospital stay was 2 days shorter in the matched comparison, which approached significance (LDP, 7.4 days vs. ODP, 9.4 days, p = 0.06). Conclusions: LDP provides similar short- and long-term oncologic outcomes as compared with OD, with potentially shorter hospital stay. These results suggest that LDP is an acceptable approach for resection of PDAC of the left pancreas in selected patients.

Original languageEnglish (US)
Pages (from-to)779-785
Number of pages7
JournalJournal of the American College of Surgeons
Volume210
Issue number5
DOIs
StatePublished - May 2010
Externally publishedYes

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Pancreatectomy
Adenocarcinoma
Survival
Length of Stay
Neoplasms
Pancreas

ASJC Scopus subject areas

  • Surgery

Cite this

Kooby, D. A., Hawkins, W. G., Schmidt, C. M., Weber, S. M., Bentrem, D. J., Gillespie, T. W., ... Lillemoe, K. D. (2010). A Multicenter Analysis of Distal Pancreatectomy for Adenocarcinoma: Is Laparoscopic Resection Appropriate? Journal of the American College of Surgeons, 210(5), 779-785. https://doi.org/10.1016/j.jamcollsurg.2009.12.033

A Multicenter Analysis of Distal Pancreatectomy for Adenocarcinoma : Is Laparoscopic Resection Appropriate? / Kooby, David A.; Hawkins, William G.; Schmidt, C. Max; Weber, Sharon M.; Bentrem, David J.; Gillespie, Theresa W.; Sellers, Johnita Byrd; Merchant, Nipun B.; Scoggins, Charles R.; Martin, Robert C G; Kim, Hong Jin; Ahmad, Syed; Cho, Clifford S.; Parikh, Alexander A.; Chu, Carrie K.; Hamilton, Nicholas; Doyle, Courtney J.; Pinchot, Scott; Hayman, Amanda; McClaine, Rebecca; Nakeeb, Attila; Staley, Charles A.; McMasters, Kelly M.; Lillemoe, Keith D.

In: Journal of the American College of Surgeons, Vol. 210, No. 5, 05.2010, p. 779-785.

Research output: Contribution to journalArticle

Kooby, DA, Hawkins, WG, Schmidt, CM, Weber, SM, Bentrem, DJ, Gillespie, TW, Sellers, JB, Merchant, NB, Scoggins, CR, Martin, RCG, Kim, HJ, Ahmad, S, Cho, CS, Parikh, AA, Chu, CK, Hamilton, N, Doyle, CJ, Pinchot, S, Hayman, A, McClaine, R, Nakeeb, A, Staley, CA, McMasters, KM & Lillemoe, KD 2010, 'A Multicenter Analysis of Distal Pancreatectomy for Adenocarcinoma: Is Laparoscopic Resection Appropriate?', Journal of the American College of Surgeons, vol. 210, no. 5, pp. 779-785. https://doi.org/10.1016/j.jamcollsurg.2009.12.033
Kooby, David A. ; Hawkins, William G. ; Schmidt, C. Max ; Weber, Sharon M. ; Bentrem, David J. ; Gillespie, Theresa W. ; Sellers, Johnita Byrd ; Merchant, Nipun B. ; Scoggins, Charles R. ; Martin, Robert C G ; Kim, Hong Jin ; Ahmad, Syed ; Cho, Clifford S. ; Parikh, Alexander A. ; Chu, Carrie K. ; Hamilton, Nicholas ; Doyle, Courtney J. ; Pinchot, Scott ; Hayman, Amanda ; McClaine, Rebecca ; Nakeeb, Attila ; Staley, Charles A. ; McMasters, Kelly M. ; Lillemoe, Keith D. / A Multicenter Analysis of Distal Pancreatectomy for Adenocarcinoma : Is Laparoscopic Resection Appropriate?. In: Journal of the American College of Surgeons. 2010 ; Vol. 210, No. 5. pp. 779-785.
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T1 - A Multicenter Analysis of Distal Pancreatectomy for Adenocarcinoma

T2 - Is Laparoscopic Resection Appropriate?

AU - Kooby, David A.

AU - Hawkins, William G.

AU - Schmidt, C. Max

AU - Weber, Sharon M.

AU - Bentrem, David J.

AU - Gillespie, Theresa W.

AU - Sellers, Johnita Byrd

AU - Merchant, Nipun B.

AU - Scoggins, Charles R.

AU - Martin, Robert C G

AU - Kim, Hong Jin

AU - Ahmad, Syed

AU - Cho, Clifford S.

AU - Parikh, Alexander A.

AU - Chu, Carrie K.

AU - Hamilton, Nicholas

AU - Doyle, Courtney J.

AU - Pinchot, Scott

AU - Hayman, Amanda

AU - McClaine, Rebecca

AU - Nakeeb, Attila

AU - Staley, Charles A.

AU - McMasters, Kelly M.

AU - Lillemoe, Keith D.

PY - 2010/5

Y1 - 2010/5

N2 - Background: As compared with open distal pancreatectomy (ODP), laparoscopic distal pancreatectomy (LDP) affords improved perioperative outcomes. The role of LDP for patients with pancreatic ductal adenocarcinoma (PDAC) is not defined. Study Design: Records from patients undergoing distal pancreatectomy (DP) for PDAC from 2000 to 2008 from 9 academic medical centers were reviewed. Short-term (node harvest and margin status) and long-term (survival) cancer outcomes were assessed. A 3:1 matched analysis was performed for ODP and LDP cases using age, American Society of Anesthesiologists (ASA) class, and tumor size. Results: There were 212 patients who underwent DP for PDAC; 23 (11%) of these were approached laparoscopically. For all 212 patients, 56 (26%) had positive margins. The mean number of nodes (± SD) examined was 12.6 ±8.4 and 114 patients (54%) had at least 1 positive node. Median overall survival was 16 months. In the matched analysis there were no significant differences in positive margin rates, number of nodes examined, number of patients with at least 1 positive node, or overall survival. Logistic regression for all 212 patients demonstrated that advanced age, larger tumors, positive margins, and node positive disease were independently associated with worse survival; however, method of resection (ODP vs. LDP) was not. Hospital stay was 2 days shorter in the matched comparison, which approached significance (LDP, 7.4 days vs. ODP, 9.4 days, p = 0.06). Conclusions: LDP provides similar short- and long-term oncologic outcomes as compared with OD, with potentially shorter hospital stay. These results suggest that LDP is an acceptable approach for resection of PDAC of the left pancreas in selected patients.

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