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Randomized Controlled Trial
. 2025 Dec 1;282(6):930-938.
doi: 10.1097/SLA.0000000000006681. Epub 2025 Feb 25.

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

Chen Liu  1   2   3   4 , He Cheng  1   2   3   4 , Min Wang  5 , Yunqiang Cai  6 , Chongyi Jiang  7 , Liang Tang  8 , Guopei Luo  1   2   3   4 , Kaizhou Jin  1   2   3   4 , Shunrong Ji  1   2   3   4 , Wenyan Xu  1   2   3   4 , Si Shi  1   2   3   4 , Xu Wang  1   2   3   4 , Meng Liu  7 , Weihong Zhao  9 , Xiaowu Xu  1   2   3   4 , Jin Xu  1   2   3   4 , Weiding Wu  1   2   3   4 , Wei Wang  1   2   3   4 , Jianhua Liu  9 , Chenghao Shao  8 , Bing Peng  6 , Renyi Qin  5 , Xianjun Yu  1   2   3   4 ; Chinese Study Group for Pancreatic Cancer (CSPAC)
Collaborators, Affiliations
Randomized Controlled Trial

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

Chen Liu et al. Ann Surg. .

Abstract

Objective: To evaluate the oncological superiority of laparoscopic distal pancreatectomy (LDP) versus open distal pancreatectomy (OPD) in left-sided pancreatic cancer.

Background: The oncological efficacy of LDP in left-sided pancreatic cancer remains controversial.

Methods: 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.

Results: 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.

Conclusions: Although LDP did not provide significant oncological benefits for left-sided pancreatic cancer, it was safe, applicable, and appropriate.

Keywords: distal pancreatectomy; laparoscopic surgery; open surgery; pancreatic cancer.

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Conflict of interest statement

The authors report no conflicts of interest.

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