Outcomes of minimally invasive distal pancreatectomy in patients with a history of major upper abdominal surgery.

Background: Minimally invasive distal pancreatectomy (MIDP) is favored for left-sided pancreatic tumors, but its safety and feasibility in patients with prior upper abdominal surgery (PUAS), especially major PUAS, remain uncertain.

Methods: This retrospective cohort study analyzed 1713 patients undergoing MIDP at a single tertiary center from 2009 to 2020. Patients were divided into three groups: those with no prior abdominal surgery (no-PAS, n = 1612), those with minor PUAS (n = 58), and those with major PUAS (n = 43). Primary and secondary endpoints included complications of Clavien-Dindo grade III or higher, conversion to open surgery, length of hospital stay, 90-day mortality, and readmission rates.

Results: Among the 1713 patients who underwent MIDP, no significant differences in the rate of severe complications (Clavien-Dindo grade III or higher) were observed between the no-PAS group (9.4%) and either the minor-PUAS (10.3%, p = 0.991) or major-PUAS (7.0%, p = 0.792) groups. Conversion to open surgery occurred in 3.5% of patients in the no-PAS group, with slightly higher rates in the minor-PUAS (5.2%, p = 0.266) and major-PUAS (7.0%, p = 0.202) groups; however, these differences were not statistically significant. Length of hospital stay, 90-day mortality, and readmission rates were comparable across groups.

Conclusion: MIDP appears to be a safe and feasible option for selected patients with PUAS, including major procedures, without significantly increasing the risks of severe complications or conversion to open surgery. These findings support the broader use of MIDP in patients with complex surgical histories.