Minimally Invasive or Open Distal Pancreatectomy--Thoughts?

How does minimally invasive distal pancreatectomy (MIDP) compare with conventional open surgery for the surgical management of patients with pathology in the distal pancreas? In a study published in Annals of Surgery,^[1] the authors designed a multicenter randomized trial in 14 Dutch surgical centers comparing outcomes in 51 patients with MIDP with outcomes in 57 patients with conventional open surgery.

In the MIDP group, time to functional recovery was 2 days shorter (P < .001), blood loss was reduced (150 mL vs 400 mL; P < .001), and patient-reported quality-of-life scores were better (P = .003). The number of complications in the two groups was similar (P = .21).

Where Does This Trial Leave Us?

In this randomized patient-blinded trial, a minimally invasive approach to managing lesions in the distal pancreas yielded early results that compared favorably with traditional open surgery. The main benefits were a significant drop in length of stay and an improvement in the postoperative quality-of-life score. Similar results have been observed in many reports comparing open with laparoscopic surgery for other organs.^[2,3,4]

This study was performed in highly organized Dutch surgical centers, where all surgeons had completed dedicated training programs and had performed at least 20 distal pancreatectomies. Each center had performed at least 20 pancreaticoduodenectomies yearly. The results might be different in other regions with less developed quality control measures.

For the 21 patients with pancreatic ductal adenocarcinoma, the study was not designed to include long-term survival. This issue needs to be examined in a larger study with longer follow-up.

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