Multicenter comparative study of laparoscopic and open distal pancreatectomy using propensity score-matching

Background Laparoscopic distal pancreatectomy has been shown to be associated with favorable postoperative outcomes using meta-analysis. However, there have been no randomized controlled studies yet. This study aimed to compare laparoscopic and open distal pancreatectomy using propensity score-matching. Methods We retrospectively collected perioperative data of 2,266 patients who underwent distal pancreatectomy in 69 institutes from 2006-2013 in Japan. Among them, 2,010 patients were enrolled in this study and divided into two groups, laparoscopic distal pancreatectomy and open distal pancreatectomy. Perioperative outcomes were compared between the groups using unmatched and propensity matched analysis. Results After propensity score-matching, laparoscopic distal pancreatectomy was associated with favorable perioperative outcomes compared with open distal pancreatectomy, including higher rate of preservation of spleen and splenic vessels (P < 0.001); lower rates of intraoperative transfusion (P = 0.020), clinical grade of pancreatic fistula (International Study Group on Pancreatic Fistula grade B and C; P < 0.001), and morbidity (P < 0.001); and shorter hospital stay (P = 0.001), but a longer operative time (P < 0.001). Conclusions Laparoscopic distal pancreatectomy was associated with more favorable perioperative outcomes than open distal pancreatectomy. Nakamura and colleagues conducted the largest multicenter propensity score matched study to date comparing laparoscopic and open distal pancreatectomy, based on data from 2,266 patients. The laparoscopic procedure was associated with significantly more favorable short-term postoperative outcomes than open surgery, particularly in terms of morbidity and development of pancreatic fistulas.