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Basso et al. Mini-invasive distal pancreatectomy

removed when the presence of a pancreatic fistula by cystic tumours (2 serous and 1 mucinous in LDP
was ruled out, according to the clinical and laboratory vs. 2 serous and 2 mucinous in ODP). Other findings
findings. in the LDP group included two intraductal papillary
mucinous neoplasms (IPMN), one hematoma,
The enhanced recovery-after-surgery (ERAS) and a lymphoepithelial cyst, whereas one ductal
programme, including early oral intake, mobilization, adenocarcinoma, one IPMN, an epithelial cyst, and
and specific instructions for the management of drains an inflamed pancreas were found in the ODP group.
and nasogastric tubes, was applied in all patients. [10] The intra- and postoperative results are displayed in
Table 2. Both the size of the specimen (5.33 ± 3.2
Statistical analysis vs. 5.58 ± 2.57 cm, P = 0.8033) and the number of
The data are reported as mean ± standard deviation the removed lymph nodes (10.5 ± 4.3 vs. 12.1 ± 3.1,
(SD). To compare continuous and dichotomized P = 0.3071) were similar (P = NS). In three cases of
variables, we used the Mann-Whitney U-test LDP, the size of the lesion was more than 8 cm and
(assuming that the data were not normally distributed) required a Pfannenstiel incision for extraction of the
and the Fisher exact probability test (because most cell surgical specimen. None of the patients in the LDP
group were converted to an open approach.
frequencies were ≤ 5), respectively. The relationship
between parameters was evaluated using Pearson’s Laparoscopic pancreatectomy required a longer
correlation coefficient calculation, and the relation line operative time (197.5 ± 33.7 vs. 122.5 ± 35.4 min, P
equations were also obtained. A P-value < 0.05 was = 0.00034). However, in this group of patients both
considered statistically significant. postoperative pain intensity measured by a VAS scale
(P = 0.0009) and the hospital stay (P = 0.0014) were
RESULTS significantly reduced, and the patients had an earlier
bowel canalization (48 ± 23 vs. 92 ± 17 h, P = 0.001)
Twelve patients (6 men and 6 women, median age [Table 2].
68, range 57 to 78 years) underwent LDP (group A),
while 12 patients (5 men and 7 women, median age Table 3 summarizes correlations between operative time
71, range 59 to 79 years) underwent ODP (group B), (OT) or hospital LoS and age, BMI, and intraoperative
for benign or malignant diseases. bleeding (IB), to evaluate whether there is any
relationship between main variables. In both groups
Table 1 reports the main population characteristics (LDP vs. ODP) the age did not affect operative time (R
and shows that the two groups were homogeneous = 0.338, P = 0.226 vs. R = 0.9002, P = 0.996), which
(P = NS) with respect to age, male/female ratio, ASA was related to the intraoperative bleeding (R = 0.797, P
score, and BMI. In addition, the pathological findings = 0.002 vs. 0.616, P = 0.003). A significant relationship
did not differ (P = NS) between groups. Pancreatic between LoS and age (R = 0.578, P = 0.040) and
neuroendocrine tumour (NET) was the main between the operative time and BMI (R = 0.787, P =
diagnosis (5 in LDP group and 4 in ODP), followed 0.002) was found only in group ODP [Figure 2A and B].

Table 1: Population’s characteristics
Parameters Laparoscopic distal pancreatectomy Open distal pancreatectomy P-value
Number of patients 12 12 -
Age (years) 68.08 ± 6.73 70.5 ± 6.9 0.2531
Male/female ratio 6:6 5:7 0.6801
ASA 2.08 ± 0.51 2.33 ± 0.49 0.2247
BMI (range) 26.92 ± 2.97 (24-35) 27.83 ± 4.02 (22-37) 0.7843
ASA: American Society of Anaesthesiologists; BMI: body mass index

Table 2: Intra- and postoperative results
Laparoscopic distal Open distal
Results P-value
pancreatectomy pancreatectomy
Length of surgery, min (range) 197.5 ± 33.74 (160-285) 122.5 ± 34.54 (90-215) 0.00034
Estimated blood loss, mL (range) 100.83 ± 32.04 (60-180) 180 ± 39.77 (120-250) 0.0001
Tumor size, cm (range) 5.33 ± 3.2 (1.2-12.5) 5.58 ± 2.57 (3-11) 0.8033
Number of removed lymph nodes (range) 10.55 ± 4.3 (6-19) 12.08 ± 3.12 (8-18) 0.3071
Post-operative VAS (on days I-II) 4.08 ± 1.16 5.92 ± 1.24 0.0009
Resumption of canalization, hours after surgery (range) 48 ± 22.88 (24-96) 92 ± 17.23 (72-120) 0.001
Resumption of solid oral feeding, days after surgery (range) 2.42 ± 0.67 (2-4) 3.4 ± 1.38 (2-6) 0.1403
VAS: visual analogue scale
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