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Comparable long-term oncologic outcomes of laparoscopic versus open pancreaticoduodenectomy for adenocarcinoma: a propensity score weighting analysis

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Abstract

Background

To date, no study has reported long-term oncologic outcome for patients undergoing laparoscopic pancreaticoduodenectomy (LPD) compared to open surgery (OPD). The aim of this study is assess long-term oncologic outcomes for patients with adenocarcinoma undergoing LPD versus OPD using propensity score weighting modeling to minimize selection bias.

Patients and methods

All patients undergoing PD at Institut Mutualiste Montsouris between January 2000 and April 2010 were included. Propensity scores were calculated using multivariate logistic regression, relating preoperative covariates to surgical approach. Logistic regression was performed, and Cox proportional hazards models for postoperative outcomes were constructed, with and without adjustment for propensity scores weights.

Results

Among 87 patients who underwent PD, 40 underwent LPD and 25 OPD for confirmed adenocarcinoma. Preoperative covariates across both groups were comparable. The median follow-up time was 34.5 months. During follow-up, metastasis was identified in 16 (40%) LPD and 7 (28%) OPD patients. After propensity score adjustment, the median overall survival (OS) was 35.5 versus 29.6 months, respectively. The 1-, 3-, and 5-year OS rates were 80.5, 49.2, 39.7% and 77.8, 46.4, 30% in the LP and OPD groups (P = 0.41, 0.42, 0.25), respectively. The median recurrence-free survival (RFS) was 21.5 versus 13.7 months (LPD vs. OPD), and the 1-, 3-, and 5-year RFS rates were 70.9, 33.3, 21.9% and 62.3, 37.9, 25.7% in the LP and OPD groups (P = 0.27, 0.37, 0.39), respectively.

Conclusions

Due to the early adoption of LPD, this study is the first to report on long-term oncologic safety of LPD: LPD is non-inferior to OPD with respect to long-term outcomes for patients with adenocarcinoma.

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Acknowledgements

The University of Texas MD Anderson Cancer Center is supported in part by the NIH/NCI under Award Number P30CA016672

Author contributions

Idea conception: CC, VB, GP, DZ, LL, HCC, DF, BG. Data collection: CC, VB, GP, DZ, BG. Writing: CC, VB, GP, DZ, LL, HCC, DF, BG. Data analysis: CC, VB, GP, DZ, LL, HCC, DF, BG. Critical revision: CC, VB, GP, DZ, LL, HCC, DF, BG.

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Authors and Affiliations

  1. Department of Surgical Oncology, Hepato-Pancreato-Biliary Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX, USA

    Claudius Conrad, Guillaume Passot & Daria Zorzi

  2. Department of Digestive Diseases, L’Institute Mutualiste Montsouris, Paris, France

    Claudius Conrad, Valeria Basso, David Fuks & Brice Gayet

  3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Liang Li & Hsiang-Chun Chen

Authors
  1. Claudius Conrad
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  2. Valeria Basso
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  3. Guillaume Passot
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  4. Daria Zorzi
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  6. Hsiang-Chun Chen
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  7. David Fuks
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  8. Brice Gayet
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Correspondence to Claudius Conrad.

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Disclosures

Drs. Claudius Conrad, Valeria Basso, Guillaume Passot, Daria Zorzi, Liang Li, Hsiang-Chun Chen, David Fuks, and Brice Gayet have no conflicts of interest or financial ties to disclose.

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Conrad, C., Basso, V., Passot, G. et al. Comparable long-term oncologic outcomes of laparoscopic versus open pancreaticoduodenectomy for adenocarcinoma: a propensity score weighting analysis. Surg Endosc 31, 3970–3978 (2017). https://doi.org/10.1007/s00464-017-5430-3

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  • DOI: https://doi.org/10.1007/s00464-017-5430-3

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