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KMID : 0978820110140020042
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Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons
2011 Volume.14 No. 2 p.42 ~ p.50
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Comparison of Laparoscopic and Open Distal Pancreatectomy with Focus on the Development of Postoperative Pancreatic Fistula
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Park Ho-Jong
Nah Yang-Won
Nam Chang-Woo
Bang Sung-Jo
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Abstract
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Purpose: To assess the technical feasibility of laparoscopic distal pancreatectomy (LDP) focusing on the development of postoperative complications including pancreatic fistula (POPF).
Methods: From March 2001 to April 2010, 57 patients underwent a distal pancreatectomy. The patients were divided into two groups, LDP group (L group, n=15) and open distal pancreatectomy group (O group, n=42). The clinicopathological characteristics, surgical variables and postoperative outcomes of these 2 groups were compared retrospectively.
Results: Patients with a malignancy constituted 7% of the L group and 31% of the O group (p=0.084). The tumor size was significantly larger in the O group (2.6 vs. 5.3 cm). The body mass index (BMI) was significantly higher in the L group (24.9 vs. 22.9 kg/m2). One case of a pancreas pseudocyst in the L group was converted to open surgery due to intraoperative bleeding. The L group showed significantly lessintraoperative bleeding, earlier start of solid meals and shorter hospital stay. There was no significant difference in the incidence of postoperative complications and POPF between the 2 groups. POPF of ISGPF grade B developed in 0 and 2 patients in the L group and O group, respectively. One intestinal obstruction and 1 fluid collection that required intervention was encountered in the O group. One patient with adenocarcinoma who underwent LDP was alive 25 months after surgery without recurrence.
Conclusion: LDP provides the advantages of minimal access surgery with a comparable rate of POPF to ODP. LDP is considered suitable for benign and borderline-malignant pancreatic lesions.
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KEYWORD
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Laparoscopic distal pancreatectomy, Pancreatectomy, Pancreas neoplasm
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