Laparoscopic left pancreatectomy is safe for the treatment of pancreatic ductal adenocarcinoma treated by chemoradiotherapy compared to open left pancreatectomy: a single-center retrospective study.

BACKGROUND: Neoadjuvant chemoradiotherapy (NACRT) has become a standard in the treatment of borderline and locally advanced pancreatic ductal adenocarcinomas (PDAC). Left pancreatectomy (LP) is the procedure of choice for body and tail PDAC. Only a few data compare the outcomes of laparoscopic and open LP (LLP, OLP) after NACRT. METHODS: A monocentric retrospective cohort of patients who underwent LLP or OLP for PDAC after NACRT between 2012 and 2024. RESULTS: We included 57 patients, 22 LLP (39%) and 35 OLP (61%) with no difference regarding demographic characteristics. LLP compared to OLP showed less median blood loss (100 vs. 300 mL, p = 0.002), shorter median operative time (210 vs. 255 min, p = 0.003), and median length of stay (8 vs. 14 days, p < 0.001). Rates of Clavien III-IV complications (0 vs. 9%; p = 0.276), mortality (0% vs. 6%, p = 0.518) and grade B/C postoperative pancreatic fistula (0 vs. 3%; p = 1.00) were similar. Median tumor size (25 vs. 21 mm, p = 0.657), median number of harvested lymph nodes (15 vs. 21, p = 0.185), and R0 resection rate (86% for both, p = 1.00) were similar as well. Three-year and five-year overall and disease-free survival were comparable. CONCLUSION: NACRT does not seem to compromise the benefits of laparoscopic surgery as LLP has comparable surgical and oncological outcomes compared to OLP.