Laparoscopic versus open extended radical left pancreatectomy for pancreatic ductal adenocarcinoma: an international propensity-score matched study

A. Balduzzi*, J. van Hilst, M. Korrel, S. Lof, B. Al-Sarireh, A. Alseidi, F. Berrevoet, B. Bjornsson, P. van den Boezem, U. Boggi, O.R. Busch, G. Butturini, R. Casadei, R. van Dam, S. Dokmak, B. Edwin, M.A. Sahakyan, G. Ercolani, J.M. Fabre, M. FalconiA. Forgione, B. Gayet, D. Gomez, B.G. Koerkamp, T. Hackert, T. Keck, I. Khatkov, C. Krautz, R. Marudanayagam, K. Menon, A. Pietrabissa, I. Poves, A.S. Cunha, R. Salvia, S. Sanchez-Cabus, Z. Soonawalla, M. Abu Hilal*, M.G. Besselink*, European Consortium on Minimally Invasive Pancreatic Surgery (E- MIPS)

*Corresponding author for this work

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Background A radical left pancreatectomy in patients with pancreatic ductal adenocarcinoma (PDAC) may require extended, multivisceral resections. The role of a laparoscopic approach in extended radical left pancreatectomy (ERLP) is unclear since comparative studies are lacking. The aim of this study was to compare outcomes after laparoscopic vs open ERLP in patients with PDAC. Methods An international multicenter propensity-score matched study including patients who underwent either laparoscopic or open ERLP (L-ERLP; O-ERLP) for PDAC was performed (2007-2015). The ISGPS definition for extended resection was used. Primary outcomes were overall survival, margin negative rate (R0), and lymph node retrieval. Results Between 2007 and 2015, 320 patients underwent ERLP in 34 centers from 12 countries (65 L-ERLP vs. 255 O-ERLP). After propensity-score matching, 44 L-ERLP could be matched to 44 O-ERLP. In the matched cohort, the conversion rate in L-ERLP group was 35%. The L-ERLP R0 resection rate (matched cohort) was comparable to O-ERLP (67% vs 48%; P = 0.063) but the lymph node yield was lower for L-ERLP than O-ERLP (median 11 vs 19, P = 0.023). L-ERLP was associated with less delayed gastric emptying (0% vs 16%, P = 0.006) and shorter hospital stay (median 9 vs 13 days, P = 0.005), as compared to O-ERLP. Outcomes were comparable for additional organ resections, vascular resections (besides splenic vessels), Clavien-Dindo grade >= III complications, or 90-day mortality (2% vs 2%, P = 0.973). The median overall survival was comparable between both groups (19 vs 20 months, P = 0.571). Conversion did not worsen outcomes in L-ERLP. Conclusion The laparoscopic approach may be used safely in selected patients requiring ERLP for PDAC, since morbidity, mortality, and overall survival seem comparable, as compared to O-ERLP. L-ERLP is associated with a high conversion rate and reduced lymph node yield but also with less delayed gastric emptying and a shorter hospital stay, as compared to O-ERLP.
Original languageEnglish
Pages (from-to)6949-6959
Number of pages11
JournalSurgical endoscopy and other interventional techniques
Issue number12
Early online date4 Jan 2021
Publication statusPublished - Dec 2021


  • cancer
  • classification
  • cohort
  • definition
  • distal pancreatectomy
  • erlp
  • extended resection
  • left pancreatectomy
  • pancreatosplenectomy
  • pdac
  • surgery
  • surgical complications
  • Left pancreatectomy
  • ERLP
  • PDAC
  • Extended resection

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