Surgical Endoscopy

, Volume 32, Issue 5, pp 2239–2248 | Cite as

Comparison of laparoscopic to open pancreaticoduodenectomy in elderly patients with pancreatic adenocarcinoma

  • Brandon C. Chapman
  • Csaba Gajdos
  • Patrick Hosokawa
  • William Henderson
  • Alessandro Paniccia
  • Douglas M. Overbey
  • Ana Gleisner
  • Richard D. Schulick
  • Martin D. McCarter
  • Barish H. Edil



The purpose of the study is to compare perioperative and survival outcomes in elderly patients undergoing laparoscopic pancreaticoduodenectomy (LPD) to those undergoing open pancreaticoduodenectomy (OPD).


Patients aged ≥ 75 years with pancreatic adenocarcinoma undergoing LPD or OPD were identified from the NCDB (2010–2013). Baseline characteristics and perioperative outcomes were compared using a χ 2 and Student’s t test. The Kaplan–Meier method was used to generate survival curves, and differences were tested using a log-rank test. A multivariate cox proportional hazard model was applied to estimate the hazard ratio (HR) of LPD on overall survival (OS).


We identified 1768 patients aged ≥ 75 years who underwent LPD (n = 248, 14.0%) or OPD (n = 1520, 86.0%). The majority of patients in the LPD group had their surgery at facilities performing less than 5 LPDs per year (n = 165, 66.5%). 90-day mortality was significantly lower in the LPD compared to the OPD (7.2 vs. 12.2%, p = 0.049). The laparoscopic conversion rate was 30% (n = 74) and was associated with higher readmission rates (13.5 vs. 8.1%), 30-day mortality (8.0 vs. 3.8%), and 90-day mortality (10.4 vs. 6.0%), but these did not reach statistical significance. Median OS was significantly longer in the LPD group (19.8 vs. 15.6 months, p = 0.022). After adjusting for patient and tumor-related characteristics, there was a trend towards improved survival in the LPD group (HR 0.85, 95% CI 0.69–1.03).


The vast majority of the NCDB participating facilities perform less than 5 LPD cases per year, which was associated with an increased risk of perioperative mortality. Overall 90-day mortality was significantly lower in the LPD group and there was a trend towards improved OS in the LPD group compared to the OPD group after adjusting for patient and tumor-related characteristics. Studies with increased sample size and longer follow-up are needed before definitive conclusions can be made.


Pancreaticoduodenectomy Minimally invasive surgical procedures Laparoscopy Pancreatic cancer, adult Aged 



This research was not funded and did not receive any specific grant funding from agencies in the public, commercial, or not-for-profit sectors. This data has not been previously presented.

Compliance with ethical standards


Drs. Brandon C. Chapman, Csaba Gajdos, Patrick Hosokawa, William Henderson, Alessandro Paniccia, Douglas M. Overbey, Ana Gleisner, Richard D. Schulick, Martin D. McCarter, and Barish H. Edil have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Brandon C. Chapman
    • 1
  • Csaba Gajdos
    • 1
  • Patrick Hosokawa
    • 2
  • William Henderson
    • 2
  • Alessandro Paniccia
    • 1
  • Douglas M. Overbey
    • 1
  • Ana Gleisner
    • 1
  • Richard D. Schulick
    • 1
  • Martin D. McCarter
    • 1
  • Barish H. Edil
    • 3
  1. 1.Department of SurgeryUniversity of Colorado School of MedicineAuroraUSA
  2. 2.Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS)AuroraUSA
  3. 3.Division of Surgical OncologyUniversity of Colorado School of MedicineAuroraUSA

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