Advertisement

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
Article

Abstract

Introduction

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).

Methods

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).

Results

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).

Conclusion

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.

Keywords

Pancreaticoduodenectomy Minimally invasive surgical procedures Laparoscopy Pancreatic cancer, adult Aged 

Notes

Funding

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

Disclosure

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.

References

  1. 1.
    Ortman JM VV, Hogan H (2014) An aging nation: the older population in the United States. Current Population Reports, U.S. Census Bureau, Washington, DCGoogle Scholar
  2. 2.
    Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM (2014) Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res 74:2913–2921CrossRefPubMedGoogle Scholar
  3. 3.
    Coolsen MM, Bakens M, van Dam RM, Olde Damink SW, Dejong CH (2015) Implementing an enhanced recovery program after pancreaticoduodenectomy in elderly patients: is it feasible? World J Surg 39:251–258CrossRefPubMedGoogle Scholar
  4. 4.
    Ito Y, Kenmochi T, Irino T, Egawa T, Hayashi S, Nagashima A, Kitagawa Y (2011) The impact of surgical outcome after pancreaticoduodenectomy in elderly patients. World J Surg Oncol 9:102CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Kang CM, Kim JY, Choi GH, Kim KS, Choi JS, Lee WJ, Kim BR (2007) Pancreaticoduodenectomy of pancreatic ductal adenocarcinoma in the elderly. Yonsei Med J 48:488–494CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Sohn TA, Yeo CJ, Cameron JL, Lillemoe KD, Talamini MA, Hruban RH, Sauter PK, Coleman J, Ord SE, Grochow LB, Abrams RA, Pitt HA (1998) Should pancreaticoduodenectomy be performed in octogenarians? J Gastrointest Surg 2:207–216CrossRefPubMedGoogle Scholar
  7. 7.
    Tani M, Kawai M, Hirono S, Ina S, Miyazawa M, Nishioka R, Shimizu A, Uchiyama K, Yamaue H (2009) A pancreaticoduodenectomy is acceptable for periampullary tumors in the elderly, even in patients over 80 years of age. J Hepatobiliary Pancreat Surg 16:675–680CrossRefPubMedGoogle Scholar
  8. 8.
    Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 241:232–237CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229CrossRefPubMedGoogle Scholar
  10. 10.
    Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484CrossRefPubMedGoogle Scholar
  11. 11.
    Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRefGoogle Scholar
  12. 12.
    Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52CrossRefPubMedGoogle Scholar
  13. 13.
    Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 246:655–662 (discussion 662–654)CrossRefPubMedGoogle Scholar
  14. 14.
    Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report: a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 251:417–420CrossRefPubMedGoogle Scholar
  15. 15.
    Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y (2002) A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131:S306–S311CrossRefGoogle Scholar
  16. 16.
    Tozzi R, Malur S, Koehler C, Schneider A (2005) Laparoscopy versus laparotomy in endometrial cancer: first analysis of survival of a randomized prospective study. J Minim Invasive Gynecol 12:130–136CrossRefPubMedGoogle Scholar
  17. 17.
    Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, Barakat R, Pearl ML, Sharma SK (2012) Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 Study. J Clin Oncol 30:695–700CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Biere SS, van Berge Henegouwen MI, Maas KW, Bonavina L, Rosman C, Garcia JR, Gisbertz SS, Klinkenbijl JH, Hollmann MW, de Lange ES, Bonjer HJ, van der Peet DL, Cuesta MA (2012) Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 379:1887–1892CrossRefPubMedGoogle Scholar
  19. 19.
    Gagner M, Pomp A (1994) Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 8:408–410CrossRefPubMedGoogle Scholar
  20. 20.
    Wang M, Cai H, Meng L, Cai Y, Wang X, Li Y, Peng B (2016) Minimally invasive pancreaticoduodenectomy: a comprehensive review. Int J Surg 35:139–146CrossRefPubMedGoogle Scholar
  21. 21.
    Stauffer JA, Coppola A, Villacreses D, Mody K, Johnson E, Li Z, Asbun HJ (2016) Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc 31:2233CrossRefPubMedGoogle Scholar
  22. 22.
    Asbun HJ, Stauffer JA (2012) Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the accordion severity grading system. J Am Coll Surg 215:810–819CrossRefPubMedGoogle Scholar
  23. 23.
    Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagorney DM, Kendrick ML (2014) Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg 260:633–638 (discussion 638–640)CrossRefPubMedGoogle Scholar
  24. 24.
    Adam MA, Roman SA, Sosa JA (2015) Minimally invasive versus open pancreaticoduodenectomy for cancer is associated with increased 30-day mortality. Ann Surg 262:372CrossRefPubMedGoogle Scholar
  25. 25.
    Kannan U, Reddy VS, Mukerji AN, Parithivel VS, Shah AK, Gilchrist BF, Farkas DT (2015) Laparoscopic vs open partial colectomy in elderly patients: insights from the American College of Surgeons: National Surgical Quality Improvement Program database. World J Gastroenterol 21:12843–12850CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Dimick JB, Cowan JA Jr, Colletti LM, Upchurch GR Jr (2004) Hospital teaching status and outcomes of complex surgical procedures in the United States. Arch Surg 139:137–141CrossRefPubMedGoogle Scholar
  27. 27.
    Gooiker GA, van Gijn W, Wouters MW, Post PN, van de Velde CJ, Tollenaar RA (2011) Systematic review and meta-analysis of the volume-outcome relationship in pancreatic surgery. Br J Surg 98:485–494CrossRefPubMedGoogle Scholar
  28. 28.
    Hyder O, Sachs T, Ejaz A, Spolverato G, Pawlik TM (2013) Impact of hospital teaching status on length of stay and mortality among patients undergoing complex hepatopancreaticobiliary surgery in the USA. J Gastroint Surg 17:2114–2122CrossRefGoogle Scholar
  29. 29.
    Surveillance E, Results Program End SEER Stat Fact Sheets: Pancreas CancerGoogle Scholar
  30. 30.
    Oguro S, Shimada K, Kishi Y, Nara S, Esaki M, Kosuge T (2013) Perioperative and long-term outcomes after pancreaticoduodenectomy in elderly patients 80 years of age and older. Langenbecks Arch Surg 398:531–538CrossRefPubMedGoogle Scholar
  31. 31.
    Khan S, Sclabas G, Lombardo KR, Sarr MG, Nagorney D, Kendrick ML, Donohue JH, Que FG, Farnell MB (2010) Pancreatoduodenectomy for ductal adenocarcinoma in the very elderly; is it safe and justified? J Gastrointest Surg 14:1826–1831CrossRefPubMedGoogle Scholar
  32. 32.
    Makary MA, Winter JM, Cameron JL, Campbell KA, Chang D, Cunningham SC, Riall TS, Yeo CJ (2006) Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg 10:347–356CrossRefPubMedGoogle Scholar
  33. 33.
    Network NCC (2017) NCCN guidelines version 1.2017. Pancreatic adenocarcinomaGoogle Scholar

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

Personalised recommendations