• Laurent Sulpice, Olivier Farges, Nathalie Goutte, Noelle Bendersky, Safi Dokmak, Alain Sauvanet, Jean Robert Delpero, and ACHBT French Pancreatectomy Study Group.
• *Department of HPB and Digestive Surgery, CHU Rennes Université de Rennes 1, Rennes, France †Department of Medical Informatics, Hôpital Beaujon, Clichy, France ‡Department of HPB and Pancreatic Surgery, Hôpital Beaujon, Clichy, Assistance Publique Hôpitaux de Parisd, Université Paris 7, Clichy, France §Department of Oncological Surgery, Institut Paoli Calmettes, Marseille, France.
• Ann. Surg. 2015 Nov 1;262(5):868-73; discussion 873-4.

ObjectivesThe aim of this study is to compare at a national level, the early and long-term outcome of distal pancreatectomy (DP) performed by laparoscopy (LapDP) or open surgery (OpenDP) for pancreatic ductal adenocarcinoma (PDAC).Background DataLapDP is feasible and safe for benign conditions but its use for PDAC is controversial.MethodsFrench healthcare databases were screened to identify all patients who had undergone LapDP or OpenDP for PDAC between 2007 and 2012. Endpoints were (i) 90-day mortality, (ii) morbidity, (iii) transfusion rate, (iv) length of hospital stay (LOS), and (v) long-term survival. Logistic regression and adjusted Cox models were used to compare LapDP and OpenDP with regard to these outcomes. Confounders included (i) patients' characteristics; (ii) associated surgical procedures; and (iii) characteristics of the hospital. Performance of the resulting models was determined by the area under the receiver operating characteristic (ROC) curve.ResultsOver the 6-year period, there were 2753 operations for PDAC: 2406 OpenDP and 347 LapDP (12.6%). The overall 90-day mortality rate was 5.2%; median LOS was 15 days, and median survival was 38 months. LapDP was not correlated with 90-day mortality but was associated with reduced pleuropulmonary morbidity (odds ratio (OR) 0.73, P = 0.028), blood transfusion (OR 0.44, P = 0.001), and LOS (P = 0.042), and was associated with increased survival (P = 0.0007).ConclusionsLapDP has not been adopted widely for PDAC. The early and long-term results of LapDP as currently practiced are as good as those of OpenDP. The next step in the evaluation of LapDP should be a randomized controlled trial (RCT), but such a trial is likely to suffer from insufficient recruitment.

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