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Minimally invasive versus open pancreaticoduodenectomy for distal bile duct cancer: an inverse probability of treatment weighting analysis of outcomes

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Abstract

Background

Minimally invasive pancreaticoduodenectomy (MIPD) has been extended to periampullary cancers, but the oncologic outcome of MIPD for distal bile duct cancer (DBDC) has not been confirmed yet.

Methods

Patients who underwent pancreaticoduodenectomy (PD) for DBDC of stage I–IIb from 2015 to 2019 at a tertiary referral center were identified and divided into open PD (OPD) and MIPD groups, the latter including laparoscopic and robotic procedures. Survival was compared between the two groups after inverse probability of treatment weighting (IPTW) using predetermined factors, and exploratory mediation analysis was performed using surgery-derived outcomes.

Results

MIPD (n = 81) group had more female patients (46.9% vs 31.6%, p = 0.011) and longer operation time (366.2 min vs. 279.1 min, p < 0.001) than the OPD (n = 288) group before IPTW. Otherwise, intraoperative and immediate postoperative outcomes were comparable between the two groups. In oncologic outcomes, MIPD group showed comparable 3-year overall survival (78.2% vs 75.0%, p = 0.062) and recurrence-free survival (51.2% vs 53.4%, p = 0.871) rates with OPD group before IPTW, and MIPD was not related with survival (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.29–1.26, p = 0.18) and recurrence (HR 1.01, 95% CI 0.67–1.53, p = 0.949) after IPTW with consideration of potential mediators. Sensitivity analysis using propensity score matching also showed similar results for survival (HR 0.68, 95% CI 0.32–1.44, p = 0.312) and recurrence (HR 1.12, 95% CI 0.67–1.88, p = 0.653).

Conclusion

MIPD and OPD groups showed similar postoperative and oncologic outcomes. MIPD could be a considerable treatment option without oncological compromise in high-volume centers.

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Author notes

  1. Woohyung Lee and Ki Byung Song have contributed equally to this work as first authors.

  2. Song Cheol Kim and Jae Hoon Lee have contributed equally to this work as corresponding authors.

Authors and Affiliations

  1. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Woohyung Lee, Ki Byung Song, Sarang Hong, Yejong Park, Bong Jun Kwak, Eunsung Jun, Dae Wook Hwang, Jae Hoon Lee & Song Cheol Kim

  2. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Sehee Kim

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Woohyung Lee, Ki Byung Song, Sarang Hong, Yejong Park, Bong Jun Kwak, Eunsung Jun, Dae Wook Hwang, Sehee Kim, Jae Hoon Lee, and Song Cheol Kim have no conflict of interest or financial ties to declare.

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Lee, W., Song, K.B., Hong, S. et al. Minimally invasive versus open pancreaticoduodenectomy for distal bile duct cancer: an inverse probability of treatment weighting analysis of outcomes. Surg Endosc 37, 881–890 (2023). https://doi.org/10.1007/s00464-022-09533-y

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