Quality of life after open versus laparoscopic distal pancreatectomy: long-term results from a randomized clinical trial

• Published in: BJS open Vol. 7; no. 2
• Main Authors: Johansen, Karin, Lindhoff Larsson, Anna, Lundgren, Linda, Gasslander, Thomas, Hjalmarsson, Claes, Sandström, Per, Björnsson, Bergthor
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 07.03.2023
• Subjects: Humans; Laparoscopy - adverse effects; Laparoscopy - methods; Minimally Invasive Surgical Procedures; Original; Pancreas; Pancreatectomy - methods; Quality of Life
• ISSN: 2474-9842; 2474-9842
• DOI: 10.1093/bjsopen/zrad002

Abstract Background Pancreatic surgery is rapidly transitioning towards minimally invasive methods. Positive results have been published regarding the safety and efficacy of laparoscopic distal pancreatectomy, but postoperative quality of life after operation remains relatively unexplored. The aim of this study was to assess the long-term quality of life after open versus laparoscopic distal pancreatectomy. Methods A long-term analysis of quality-of-life data after laparoscopic and open distal pancreatectomy based on the LAPOP trial (a single-centre, superiority, parallel, open-label, RCT in which patients undergoing distal pancreatectomy were randomized 1 : 1 to either the open or laparoscopic approach). Patients received the quality-of-life questionnaires QLQ-C30 and PAN26 before surgery and at 5–6 weeks, 6 months, 12 months, and 24 months after surgery. Results Between September 2015 and February 2019, a total of 60 patients were randomized, and 54 patients (26 in the open group and 28 in the laparoscopic group) were included in the quality-of-life analysis. A significant difference was observed in six domains in the mixed model analysis, with better results among patients who underwent laparoscopic surgery. At the 2-year measurement, a statistically significant difference between groups was seen in three domains, and a clinically relevant difference of 10 or more was seen in 16 domains, with better results among the patients who underwent laparoscopic resection. Conclusion Considerable differences were shown in postoperative quality of life after laparoscopic compared with open distal pancreatectomy, with better results among the patients who had undergone laparoscopic resection. Of note, some of these differences persisted up to 2 years after surgery. These results strengthen the ongoing transition from open to minimally invasive pancreatic surgery for distal pancreatectomy. Registration number: ISRCTN26912858 (http://www.controlled-trials.com). This was a long-term analysis of quality-of-life data after laparoscopic and open distal pancreatectomy based on the randomized clinical trial LAPOP. It was shown that the laparoscopic group had significantly better results in six quality-of-life domains over time. At the 2-year measurement, significant differences were shown in 3 domains and clinically relevant differences in 16 domains, with better results in the laparoscopic group.