Possibility of Incorrect Evaluation of Intraoperative Blood Loss During Open and Laparoscopic Distal Pancreatectomy

Purpose: Decreasing intraoperative blood loss is one reported advantage of laparoscopic surgery compared with open surgery. However, several reports indicate that blood loss during laparoscopic surgery may be underestimated. No studies have evaluated this possibility in laparoscopic distal pancreatectomy (LDP). Here we evaluated estimated blood loss (e-BL) compared to actual intraoperative blood loss (i-BL) during distal pancreatectomy (DP). Methods This study included 114 patients undergoing DP in our institution during the study period. We examined the relationship between i-BL and e-BL. Based on these results, we further investigated the relationship with LDP. Results The laparoscopic approach was used in a significantly higher percentage of patients in e-BL > i-BL group compared to e-BL < i-BL group (55.9% vs. 10.9%, p  < 0.0001). Within LDP group (n = 39), e-BL was significantly more than i-BL (388 ± 248 mL vs. 127 ± 160 mL; p   i-BL trend in LDP group was consistent regardless of the indication for DP. In contrast, the finding of i-BL > e-BL in ODP group was limited to patients with pancreatic cancer. Conclusion During LDP, e-BL was significantly more than i-BL. During ODP, e-BL was significantly less than i-BL, only in patients with pancreatic cancer. These results suggested the possibility of i-BL underestimation during LDP, and overestimation during ODP in cases with pancreatic cancer.