Minimally invasive pancreatoduodenectomy: is the incidence of clinically relevant postoperative pancreatic fistula comparable to that after open pancreatoduodenectomy?

Olga Kantor, Henry A. Pitt, Mark S. Talamonti, Kevin K. Roggin, David J. Bentrem, Richard A. Prinz, Marshall S. Baker*

*Corresponding author for this work

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)587-593
Number of pages7
JournalSurgery (United States)
Volume163
Issue number3
DOIs
StatePublished - Mar 1 2018

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ASJC Scopus subject areas

  • Surgery

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