Short-term Outcomes of Laparoscopic and Open Distal Pancreatectomy Using Propensity Score Analysis A Real-world Retrospective Cohort Study

Objective: This study aimed to compare the short-term outcomes between laparoscopic and open distal pancreatectomy for lesions of the distal pancreas from a real-world database. Background: Reports on the benefits of laparoscopic distal pancreatectomy include 2 randomized controlled trials; however, large-scale, real-world data are scarce. Methods: We analyzed the data of patients undergoing laparoscopic or open distal pancreatectomy for benign or malignant pancreatic tumors from April 2008 to May 2020 from a Japanese nationwide inpatient database. We performed propensity score analyses to compare the inhospital mortality, morbidity, readmission rate, reoperation rate, length of postoperative stay, and medical cost between the 2 groups. Results: From 5502 eligible patients, we created a pseudopopulation of patients undergoing laparoscopic and open distal pancreatectomy using inverse probability of treatment weighting. Laparoscopic distal pancreatectomy was associated with lower inhospital mortality during the period of admission (0.0% vs 0.7%, P<0.001) and within 30 days (0.0% vs 0.2%, P=0.001), incidence of reoperation during the period of admission (0.7% vs 1.7%, P=0.018), postpancreatectomy hemorrhage (0.4% vs 2.0%, P<0.001), ileus (1.1% vs 2.8%, P=0.007), and shorter postoperative length of stay (17 vs 20 d, P<0.001). Conclusions: The propensity score analysis revealed that laparoscopic distal pancreatectomy was associated with better outcomes than open surgery in terms of inhospital mortality, reoperation rate, postoperative length of stay, and incidence of postoperative complications such as postpancreatectomy hemorrhage and ileus.