Laparoscopic distal pancreatectomy versus laparoscopic central pancreatectomy for benign or low-grade malignant tumors in the pancreatic neck

Aims Laparoscopic distal pancreatectomy (LDP) and laparoscopic central pancreatectomy (LCP) are two surgical methods that can remove pancreatic neck lesions. However, their benefits remain controversial. We aimed to compare the benefits and limitations of LDP and LCP. Methods In total, 50 patients who underwent LDP (n = 34) or LCP (n =16) between January 2014 and November 2019 were retrospectively reviewed using our database. We analyzed their preoperative characteristics, operative data, pathological features, and postoperative outcomes. Results The baseline features of patients did not differ significantly between the two groups (P < 0.05). Compared with the LDP group, the LCP group showed significantly prolonged operation time (392 +/- 144 vs. 269 +/- 130 min, P = 0.007), time to oral intake (3.8 +/- 1.3 vs. 2.8 +/- 0.9 days, P = 0.017), and hospital stay (19.6 +/- 5.1 vs. 15.4 +/- 4.1 days, P = 0.008) as well as increased hospital expenses (10.1 +/- 6.2 vs. 6.6 +/- 1.5 WanRMB, P = 0.023). However, no significant differences were observed in conversion rate (0/16 vs. 0/34), blood loss (154 +/- 93 vs. 211 +/- 170 mL, P = 0.224), postoperative white blood cell count (10.3 +/- 2.7 vs. 11.1 +/- 3.1, P = 0.432), first random blood glucose level after operation (8.2 +/- 2.1 vs. 8.6 +/- 2.6 mmol/L, P = 0.696), and ascites amylase level on day 3 after operation (5212 [3110-14,176] vs. 3142 [604-13,761] U/L, P = 0.167) between the two groups. Moreover, no significant differences were noted in the incidence of postoperative diabetes (1/16 vs. 5/34) between the two groups. However, LCP was associated with significantly higher incidences of pancreatic fistula grades B and C (P = 0.005) and postoperative hemorrhage (P = 0.031). Conclusion Compared with the LCP, LDP is a useful and safer technique for benign or low-grade malignant tumors in the pancreatic neck.