Laparoscopic versus open left pancreatectomy: surgical stress response comparison in the porcine model

Authors: R. Pohnán 1;  M. Ryska 1;  J. Kalvach 1;  L. Hána 1;  T. Henlín 2;  J. Pejchal 3
Authors‘ workplace: Chirurgická klinika, 2. Lékařská fakulta Univerzity Karlovy a ÚVN, Praha 1;  Klinika anesteziologie, resuscitace a intenzivní medicíny, 1. Lékařská fakulta Univerzity Karlovy a ÚVN 2;  Katedra toxikologie a vojenské farmacie, Fakulta vojenského zdravotnictví, Univerzita obrany 3
Published in: Rozhl. Chir., 2018, roč. 97, č. 5, s. 234-238.
Category: Original articles


Although several techniques of laparoscopic left pancreatectomy have already been developed through experiments on animals and human patients, there is still insufficient information about their pathophysiological mechanisms, especially the impact on surgical stress.

In a group of 10 pigs, open left pancreatectomy was performed, and the other group of 10 pigs underwent laparoscopic left pancreatectomy. Postoperative stress was compared by determining serum levels of leukocytes, interleukin 1, 6 and CRP from peripheral venous blood collection. The blood was collected prior to incision, 1 and 2 hours after incision, 24 hours after the beginning of the procedure, and on the 7th postoperative day.

No statistically significant difference was found between open and laparoscopic left pancreatectomy in the measured values of leukocytes, IL-1 and 6 and CRP.

Key words:
laparoscopy – left pancreatectomy − surgical stress response − interleukin 1 − interleukin 6



1. Gagner M, Pomp A, Herrera MF. Early experience with laparoscopic resections of islet cell tumors. Surgery 1996;120:1051−4.

2. Borja-Cacho D, Al-Refaie WB, Vickers SM, et al. Laparoscopic distal pancreatectomy. J Am Coll Surg 2009;209:758−65.

3. Sui CJ, Li B, Yang JM, et al. Laparoscopic versus open distal pancreatectomy: A meta-analysis. Asian J Surg 2012;35:1−8.

4. Nigri GR, Rosman AS, Petrucciani N, et al. Metaanalysis of trials comparing minimally invasive and open distal pancreatectomies. Surg Endosc 2011;25:1642−25:

5. Soper NJ, Brunt LM, Dunnegan DL, et al. Laparoscopic distal pancreatectomy in the porcine model. Surg Endosc 1994;8:57−60.

6. Matsumoto T, Hirano S, Yada K. Safety and efficacy of laparoscopic distal pancreatectomy for the treatment of pancreatic disease. J Hepatobiliary Pancreat Surg 2005;12:65−70.

7. Fernández-Cruz L, Orduña D, Cesar-Borges G, et al. Distal pancreatectomy: en-bloc splenectomy vs spleen-preserving pancreatectomy. HPB 2005;7:93−8.

8. Ueda K, Matteotti R, Assalia A, Gagner M. Comparative evaluation of gastrointestinal transit and immune response between laparoscopic and open gastrectomy in a porcine model. J Gastrointest Surg 2006;10:39−45.

9. Naitoh T, Garcia-Ruiz A, Vladisavljevic A, et al. Gastrointestinal transit and stress response after laparoscopic vs conventional distal pancreatectomy in the canine model. Surg Endosc 2002;16:1627−30.

10. Naito Y, Tamai S, Shingu K, et al. Responses of plasma adrenocorticotropic hormone, cortisol, and cytokines during and after upper abdominal surgery. Anesthesiology 1992;77:426−31.

11. Weissman C. The metabolic response to stress: an overview and update. Anesthesiology 1990;73:308−27.

12. Iwasaki M, Edmondson M, Sakamoto A, at al. Anesthesia, surgical stress, and “long-term” outcomes. Acta Anaesthesiologica Taiwanica 2015;3:99−104.

13. Pierce RA, Spitler JA, Hawkins WG. Outcomes analysis of laparoscopic resection of pancreatic neoplasms. Surg Endosc 2007;21:579−86.

14. Goh BK, Tan YM, Chung YF. Critical appraisal of 232 consecutive distal pancreatectomies with emphasis on risk factors, outcome, and management of the postoperative pancreatic fistula: a 21-year experience at a single institution. Arch Surg 2008;143:956−65.

15. Kleeff J, Diener MK, Z’Graggen K. Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg 2007;245:573−82.

16. Vin Y, Sima CS, Getrajdman GI Jr. Management and outcomes of postpancreatectomy fistula, leak, and abscess: results of 908 patients resected at a single institution between 2000 and 2005. J Am Coll Surg 2008;207:490−20

17. Riviere D, Gurusamy KS, Kooby DA. Laparoscopic versus open distal pancreatectomy for pancreatic cancer. Cochrane Database Syst Rev 2016;4. doi: 10.1002/14651858.CD011391.pub2.

18. Braga M, Pecorelli N, Ferrari D. Results of 100 consecutive laparoscopic distal pancreatectomies: postoperative outcome, cost-benefit analysis, and quality of life assessment. Surg Endosc 2015;29:1871−8.

19. Ceppa EP, McCurdy RM, Parikh JA. Contemporary differences in postoperative outcomes following laparoscopic versus open distal pancreatectomy for pancreatic adenocarcinoma. HPB 2013;15:10−4.

20. Dancea HC, Obradovic VN, Woll NL, et al. Minimally invasive distal pancreatectomy improves outcomes compared to open at a rural tertiary care center. Surg Endosc 2012;26:351−26

21. Hu M, Zhao G, Wang F, et al. Laparoscopic versus open distal splenopancreatectomy for the treatment of pancreatic body and tail cancer: a retrospective, mid-term follow-up study at a single academic tertiary care institution. Surg Endosc 2014;28:2584−91.

22. Kooby DA, Hawkins WG, Schmidt CM, et al. A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? J Am Coll Surg 2010;210:779−85.

23. Stauffer J, Coppola A, Asbun HJ. Pancreatic surgery for pancreatic adenocarcinoma: a comparison between the laparoscopic and open surgical approach. Gastroenterology 2015;148:1166−7.

24. Zhang Y, Chen XM, Sun DL. Laparoscopic versus open distal pancreatectomy: a single-institution comparative study. World J Surg Oncol 2014;12:327.

25. De Rooij T, van Hilst J, Vogel JA. Minimally invasive versus open distal pancreatectomy (LEOPARD): study protocol for a randomized controlled trial. Trials 2017;18;166. Available from: doi: 10.1186/s13063-017-1892-9.

26. Marcovich R, Williams AL, Seifman BD, et al. A canine model to assess the biochemical stress response to laparoscopic and open surgery. J Endourol 2004;15:1005−8.

Surgery Orthopaedics Trauma surgery
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account