Effect of Laparoscopic Versus Open Distal Pancreatectomy on Recurrence-free Survival in Patients With Left-sided Pancreatic Cancer: A Randomized Controlled Trial.

Abstract

To evaluate the oncological superiority of laparoscopic distal pancreatectomy (LDP) versus open distal pancreatectomy (OPD) in left-sided pancreatic cancer. The oncological efficacy of LDP in left-sided pancreatic cancer remains controversial. We performed a multicenter, open-label, randomized controlled trial of LDP versus OPD in left-sided pancreatic cancer patients. Candidates were recruited from 6 centers in China, and randomly assigned to receive either LDP or ODP. The primary outcome was recurrence-free survival, and the secondary outcomes were overall survival, R0 resection rate, and retrieved lymph node numbers. Of the 481 eligible pancreatic cancer patients between January 9, 2019 and December 8, 2021, 306 candidates were initially enrolled and randomly assigned at 1:1 to receive either LDP or ODP. The last follow-up was performed on December 15, 2023, and 130 patients in the LDP group and 129 patients in the ODP group were included for per-protocol analysis. Median recurrence-free survival was 15.5 (12.5-18.5) months in the LDP group compared with 15 (9.5-20.5) months in the ODP group ( P = 0.471). The R0 resection rate in 2 groups was 88.5% versus 89.1%, respectively. Median retrieved lymph node numbers in 2 groups were similar [13.5 (10-20) vs 12 (7-17), P = 0.165]. Complications with a Clavien-Dindo score ≥ 3 occurred in 10 of 130 patients in the LDP group, and 11 of 129 patients in the ODP group. Although LDP did not provide significant oncological benefits for left-sided pancreatic cancer, it was safe, applicable, and appropriate.