TY - JOUR
T1 - Minimally invasive pancreatoduodenectomy
T2 - is the incidence of clinically relevant postoperative pancreatic fistula comparable to that after open pancreatoduodenectomy?
AU - Kantor, Olga
AU - Pitt, Henry A.
AU - Talamonti, Mark S.
AU - Roggin, Kevin K.
AU - Bentrem, David J.
AU - Prinz, Richard A.
AU - Baker, Marshall S.
PY - 2018/3/1
Y1 - 2018/3/1
N2 - Background: Studies evaluating the efficacy of minimally invasive approaches to pancreatoduodenectomy (MIS-PD) compared to open pancreatioduodenectomy (OPD) have been limited by selection bias and mixed outcomes. Methods: ACS-NSQIP 2014–2015 pancreas procedure-targeted data were used to identify patients undergoing PD. Intention-to-treat analysis was performed. Results: Of 7907 PD patients, 1277 (16%) underwent MIS-PD: 776 (61%) robotic or laparoscopic PD, 304 (24%) hybrid, and 197 (15%) unplanned conversions. There were no differences in demographics or comorbidities. Patients undergoing MIS-PD were less likely to have pancreatic ductal adenocarcinoma (30.9% vs 53.9%, P < 0.01) and less likely to have a dilated pancreatic duct (21.8% vs 46.7%, P < 0.01). 30-day morbidity was less for MIS-PD (63.6% vs 76.9%, P < 0.01), due to decreased delayed gastric emptying DGE) in the MIS-PD group (8.6% vs 15.5%, P < 0.01). 30-day mortality, length-of-stay, and readmissions were not significantly different. Patients undergoing MIS-PD had greater rates of CR-POPF (15.3% vs 13.0%, P = 0.03). On adjusted multivariable analysis, MIS-PD was not associated with CR-POPF (OR 1.05, 95% CI 0.87–1.26) but was associated with decreased DGE (OR 0.57, 95% CI 0.46–0.71). Conclusion: MIS-PD has comparable short-term outcomes to open PD. While CR-POPF rates are greater for MIS-PD, this increased risk appears related to case-selection bias and not inherent to the MIS-approach.
AB - Background: Studies evaluating the efficacy of minimally invasive approaches to pancreatoduodenectomy (MIS-PD) compared to open pancreatioduodenectomy (OPD) have been limited by selection bias and mixed outcomes. Methods: ACS-NSQIP 2014–2015 pancreas procedure-targeted data were used to identify patients undergoing PD. Intention-to-treat analysis was performed. Results: Of 7907 PD patients, 1277 (16%) underwent MIS-PD: 776 (61%) robotic or laparoscopic PD, 304 (24%) hybrid, and 197 (15%) unplanned conversions. There were no differences in demographics or comorbidities. Patients undergoing MIS-PD were less likely to have pancreatic ductal adenocarcinoma (30.9% vs 53.9%, P < 0.01) and less likely to have a dilated pancreatic duct (21.8% vs 46.7%, P < 0.01). 30-day morbidity was less for MIS-PD (63.6% vs 76.9%, P < 0.01), due to decreased delayed gastric emptying DGE) in the MIS-PD group (8.6% vs 15.5%, P < 0.01). 30-day mortality, length-of-stay, and readmissions were not significantly different. Patients undergoing MIS-PD had greater rates of CR-POPF (15.3% vs 13.0%, P = 0.03). On adjusted multivariable analysis, MIS-PD was not associated with CR-POPF (OR 1.05, 95% CI 0.87–1.26) but was associated with decreased DGE (OR 0.57, 95% CI 0.46–0.71). Conclusion: MIS-PD has comparable short-term outcomes to open PD. While CR-POPF rates are greater for MIS-PD, this increased risk appears related to case-selection bias and not inherent to the MIS-approach.
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U2 - 10.1016/j.surg.2017.12.001
DO - 10.1016/j.surg.2017.12.001
M3 - Article
C2 - 29454444
AN - SCOPUS:85044649231
VL - 163
SP - 587
EP - 593
JO - Surgery
JF - Surgery
SN - 0039-6060
IS - 3
ER -