ORIGINAL ARTICLE Multicenter comparative study of laparoscopic and open distal pancreatectomy using propensity score-matching Masafumi Nakamura · Go Wakabayashi · Yoshihiro Miyasaka · Masao Tanaka · Takanori Morikawa · Michiaki Unno · Hiroshi Tajima · Yusuke Kumamoto · Sohei Satoi · Masanori Kwon · Hirochika Toyama · Yonson Ku · Hideyuki Yoshitomi · Satoshi Nara · Kazuaki Shimada · Takahide Yokoyama · Shinichi Miyagawa · Yoichi Toyama · Katsuhiko Yanaga · Tsutomu Fujii · Yasuhiro Kodera · Study Group of JHBPS and JSEPS · Yasuyuki Tomiyama · Hiroaki Miyata · Takeshi Takahara · Toru Beppu · Hiroki Yamaue · Masaru Miyazaki · Tadahiro Takada © 2015 Japanese Society of Hepato-Biliary-Pancreatic Surgery The author’s affiliations are listed in the Appendix. Correspondence to: Masafumi Nakamura, Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan e-mail: mnaka@surg1.med. kyushu-u.ac.jp DOI: 10.1002/jhbp.268 Abstract Background Laparoscopic distal pancreatectomy has been shown to be associated with fa- vorable postoperative outcomes using meta-analysis. However, there have been no random- ized controlled studies yet. This study aimed to compare laparoscopic and open distal pancreatectomy using propensity score-matching. Methods We retrospectively collected perioperative data of 2,266 patients who underwent distal pancreatectomy in 69 institutes from 2006–2013 in Japan. Among them, 2,010 patients were enrolled in this study and divided into two groups, laparoscopic distal pancreatectomy and open distal pancreatectomy. Perioperative outcomes were compared between the groups using unmatched and propensity matched analysis. Results After propensity score-matching, laparoscopic distal pancreatectomy was associ- ated with favorable perioperative outcomes compared with open distal pancreatectomy, in- cluding higher rate of preservation of spleen and splenic vessels (P < 0.001); lower rates of intraoperative transfusion (P = 0.020), clinical grade of pancreatic fistula (International Study Group on Pancreatic Fistula grade B and C; P < 0.001), and morbidity (P < 0.001); and shorter hospital stay (P =0.001), but a longer operative time (P < 0.001). Conclusions Laparoscopic distal pancreatectomy was associated with more favorable peri- operative outcomes than open distal pancreatectomy. Keywords Laparoscopic distal pancreatectomy · Morbidity · Pancreatic fistula · Propensity score-matching Introduction Laparoscopic distal pancreatectomy (LDP) was first reported in 1996 by Gagner and Cuschieri [1, 2] and has since become common as a treatment method for benign pancreatic tumors due to the development of relevant surgical instruments and techniques. As LDP be- gan to be widely performed, many retrospective studies and systematic reviews showed that LDP was not inferior to open distal pancreatectomy (ODP) in terms of short-term postoper- ative outcomes and that LDP was associated with a shorter hospital stay compared with ODP [3–6]. Furthermore, some systematic reviews with meta-analysis showed that LDP is associ- ated with better short-term postoperative outcomes in terms of postoperative pain, recovery time, length of hospital stay, rate of postoperative pancreatic fistula (POPF), and postopera- tive morbidity [3, 5–8]. However, these systematic reviews using meta-analysis did not J Hepatobiliary Pancreat Sci (2015) ••:••–•• DOI: 10.1002/jhbp.268