Skip to main content

Advertisement

SpringerLink
Log in

Minimally invasive vs open pancreatoduodenectomy on oncological adequacy: a propensity score-matched analysis

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The adoption of minimally invasive pancreatoduodenectomy (MIPD) has increased over the last decade. Most of the data on perioperative and oncological outcomes derives from single-center high-volume hospitals. The impact of MIPD on oncological outcomes in a multicenter setting is poorly understood.

Methods

The National Cancer Database was utilized to perform a propensity score matching analysis between MIPD vs open pancreatoduodenectomy (OPD). The primary outcomes were lymphadenectomy ≥ 15 nodes and surgical margins. Secondary outcomes were 90-day mortality, length of stay, and overall survival.

Results

A total of 10,246 patients underwent pancreatoduodenectomy for ductal adenocarcinoma between 2010 and 2016. Among these patients, 1739 underwent MIPD. A propensity score matching analysis with a 1:2 ratio showed that the rate of lymphadenectomy ≥ 15 nodes was significantly higher for MIPD compared to OPD, 68.4% vs 62.5% (P < .0001), respectively. There was no statistically significant difference in the rate of positive margins, 90-day mortality, and overall survival. OPD was associated with an increased rate of length of stay > 10 days, 36.6% vs 33% for MIPD (P < .01). Trend analysis for the patients who underwent MIPD revealed that the rate of adequate lymphadenectomy increased during the study period, 73.1% between 2015 and 2016 vs 63.2% between 2010 and 2012 (P < .001). In addition, the rate of conversion to OPD decreased over time, 29.3% between 2010 and 2012 vs 20.2% between 2015 and 2016 (P < .001).

Conclusion

In this propensity score matching analysis, the MIPD approach was associated with a higher rate of adequate lymphadenectomy and a shorter length of stay compared to OPD. The surgical margins status, 90-day mortality, and overall survival were similar between the groups.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Cameron JL, Riall TS, Coleman J, Belcher KA (2006) One thousand consecutive pancreaticoduodenectomies. Ann Surg 244(1):10–15

    Article  Google Scholar 

  2. Tol JA, Gouma DJ, Bassi C, Dervenis C, Montorsi M, Adham M et al (2014) Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery 156(3):591–600

    Article  Google Scholar 

  3. Sood A, Meyer CP, Abdollah F, Sammon JD, Sun M, Lipsitz SR et al (2017) Minimally invasive surgery and its impact on 30-day postoperative complications, unplanned readmissions and mortality. Br J Surg 104(10):1372–1381

    Article  CAS  Google Scholar 

  4. Xu T, Hutfless SM, Cooper MA, Zhou M, Massie AB, Makary MA (2015) Hospital cost implications of increased use of minimally invasive surgery. JAMA Surg 150(5):489–490

    Article  Google Scholar 

  5. Spampinato MG, Coratti A, Bianco L, Caniglia F, Laurenzi A, Puleo F et al (2014) Perioperative outcomes of laparoscopic and robot-assisted major hepatectomies: an Italian multi-institutional comparative study. Surg Endosc 28(10):2973–2979

    Article  Google Scholar 

  6. Wright GP, Zureikat AH (2016) Development of minimally invasive pancreatic surgery: an evidence-based systematic review of laparoscopic versus robotic approaches. J Gastrointest Surg Off J Soc Surg Aliment Tract 20(9):1658–1665

    Article  Google Scholar 

  7. Zureikat AH, Borrebach J, Pitt HA, McGill D, Hogg ME, Thompson V et al (2017) Minimally invasive hepatopancreatobiliary surgery in North America: an ACS-NSQIP analysis of predictors of conversion for laparoscopic and robotic pancreatectomy and hepatectomy. HPB (Oxford) 19(7):595–602

    Article  Google Scholar 

  8. Venkat R, Edil BH, Schulick RD, Lidor AO, Makary MA, Wolfgang CL (2012) Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg 255(6):1048–1059

    Article  Google Scholar 

  9. Sun R, Yu J, Zhang Y, Liang Z, Han X (2021) Perioperative and oncological outcomes following minimally invasive versus open pancreaticoduodenectomy for pancreatic duct adenocarcinoma. Surg Endosc 35(5):2273–2285

    Article  Google Scholar 

  10. van Hilst J, de Rooij T, Klompmaker S, Rawashdeh M, Aleotti F, Al-Sarireh B et al (2019) Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA): a pan-european propensity score matched study. Ann Surg 269(1):10–17

    Article  Google Scholar 

  11. Palanivelu C, Senthilnathan P, Sabnis SC, Babu NS, SrivatsanGurumurthy S, AnandVijai N et al (2017) Randomized clinical trial of laparoscopic versus open pancreatoduodenectomy for periampullary tumours. Br J Surg 104(11):1443–1450

    Article  CAS  Google Scholar 

  12. Poves I, Burdío F, Morató O, Iglesias M, Radosevic A, Ilzarbe L et al (2018) Comparison of perioperative outcomes between laparoscopic and open approach for pancreatoduodenectomy: the PADULAP randomized controlled trial. Ann Surg 268(5):731–739

    Article  Google Scholar 

  13. van Hilst J, de Rooij T, Bosscha K, Brinkman DJ, van Dieren S, Dijkgraaf MG et al (2019) Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial. Lancet Gastroenterol Hepatol 4(3):199–207

    Article  Google Scholar 

  14. Asbun HJ, Moekotte AL, Vissers FL, Kunzler F, Cipriani F, Alseidi A et al (2020) The Miami international evidence-based guidelines on minimally invasive pancreas resection. Ann Surg 271(1):1–14

    Article  Google Scholar 

  15. Gooiker GA, Lemmens VE, Besselink MG, Busch OR, Bonsing BA, Molenaar IQ et al (2014) Impact of centralization of pancreatic cancer surgery on resection rates and survival. Br J Surg 101(8):1000–1005

    Article  CAS  Google Scholar 

  16. Sheetz KH, Nuliyalu U, Nathan H, Sonnenday CJ (2020) Association of surgeon case numbers of pancreaticoduodenectomies vs related procedures with patient outcomes to inform volume-based credentialing. JAMA Netw Open 3(4):e203850

    Article  Google Scholar 

  17. Stuart EA, King G, Imai K, Ho D (2011) MatchIt: nonparametric preprocessing for parametric causal inference. J Stat Softw. https://doi.org/10.18637/jss.v042.i08

    Article  Google Scholar 

  18. Adam MA, Choudhury K, Dinan MA, Reed SD, Scheri RP, Blazer DG III et al (2015) Minimally invasive versus open pancreaticoduodenectomy for cancer: practice patterns and short-term outcomes among 7061 patients. Ann Surg 262(2):372–377

    Article  Google Scholar 

  19. Dokmak S, Ftériche FS, Aussilhou B, Bensafta Y, Lévy P, Ruszniewski P et al (2015) Laparoscopic pancreaticoduodenectomy should not be routine for resection of periampullary tumors. J Am Coll Surg 220(5):831–838

    Article  Google Scholar 

  20. van Hilst J, de Rooij T, Abu Hilal M, Asbun HJ, Barkun J, Boggi U et al (2017) Worldwide survey on opinions and use of minimally invasive pancreatic resection. HPB (Oxford) 19(3):190–204

    Article  Google Scholar 

  21. Zureikat AH, Beane JD, Zenati MS, Al Abbas AI, Boone BA, Moser AJ et al (2021) 500 Minimally invasive robotic pancreatoduodenectomies: one decade of optimizing performance. Ann Surg 273(5):966–972

    Article  Google Scholar 

  22. Hata T, Motoi F, Ishida M, Naitoh T, Katayose Y, Egawa S et al (2016) Effect of hospital volume on surgical outcomes after pancreaticoduodenectomy: a systematic review and meta-analysis. Ann Surg 263(4):664–672

    Article  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Southern Arizona VA Health Care System, Department of Surgery, University of Arizona, Tucson, AZ, USA

    Yazan Ashouri & Helen Ho

  2. Department of Surgery, University of Arizona, Tucson, AZ, USA

    Katherine Ho, Iman Ghaderi & Taylor S. Riall

  3. Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA

    Chiu-Hsieh Hsu

  4. Department of Surgery, Texas Tech University Health Sciences Center, El Paso, TX, USA

    Ioannis T. Konstantinidis

  5. Division of General and GI Surgery, Department of Surgery, Emory University, 5673 Peachtree Dunwoody Road, Suite 680, Atlanta, GA, 30342, USA

    Felipe B. Maegawa

Authors
  1. Yazan Ashouri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katherine Ho
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Helen Ho
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chiu-Hsieh Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Iman Ghaderi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Taylor S. Riall
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ioannis T. Konstantinidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Felipe B. Maegawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Felipe B. Maegawa.

Ethics declarations

Disclosures

Drs. Yazan Ashouri, Katherine Ho, Helen Ho, Chiu-Hsieh Hsu, Iman Ghaderi, Ioannis Konstantinidis, and Felipe Maegawa have no conflicts of interest or financial ties to disclose. Dr. Taylor Riall and her husband have a diversified stock portfolio in Fidelity; owning publicly traded stock in the following companies: Apple, Abbvie, Abbott Laboratories, Amgen, Advansix, Caterpillar, Colgate Palmolive, Canadian National, Railway, Cisco Systems, Cintas Group, Facebook, General Mills, Garret Motion, Healthcare Services, Home Depot, Honeywell, IBM, Intel, Johnson and Johnson, Lockheed Martin, McDonalds, Medtronic, McCormick, 3 M, Merck, Microsoft, Nike, Pepsico, Pfizer, Parker Hannifan, Raytheon, Sherwin Williams, AT&T, United Health Group, Union Pacific, Viatris, Verizon, Walmart, Xlinx. They also have over $5000 in holdings in all but Facebook, Garrett Motion, Healthcare Services, Nike, Viatris. None of Dr. Riall’s stocks are related to this study and other research she has done.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ashouri, Y., Ho, K., Ho, H. et al. Minimally invasive vs open pancreatoduodenectomy on oncological adequacy: a propensity score-matched analysis. Surg Endosc 36, 7302–7311 (2022). https://doi.org/10.1007/s00464-022-09111-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09111-2

Keywords

Search

Navigation