Abstract
Background: Few studies have compared perioperative and oncological outcomes between minimally invasive pancreatoduodenectomy (MIPD) and open pancreatoduodenectomy (OPD) for pancreatic ductal adenocarcinoma (PDAC). Methods: A retrospective review of patients undergoing MIPD and OPD for PDAC from January 2011 to December 2017 was performed. Perioperative, oncological, and survival outcomes were analyzed before and after propensity score matching (PSM). Results: Data from 1048 patients were evaluated (76 MIPD, 972 OPD). After PSM, 73 patients undergoing MIPD were matched with 219 patients undergoing OPD. Operation times were longer for MIPD than OPD (392 vs. 327 min, p < 0.001). Postoperative hospital stays were shorter for MIPD patients than OPD patients (12.4 vs. 14.2 days, p = 0.040). The rate of overall complications and postoperative pancreatic fistula did not differ between the two groups. Adjuvant treatment rates were higher following MIPD (80.8% vs. 59.8%, p = 0.002). With the exception of perineural invasion, no differences were seen between the two groups in pathological outcomes. The median overall survival and disease-free survival rates did not differ between the groups. Conclusions: MIPD showed shorter postoperative hospital stays and comparable perioperative and oncological outcomes to OPD for selected PDAC patients. Future randomized studies will be required to validate these findings.
Highlights
Invasive surgery has become the standard of care for many surgical procedures across different specialties and is currently standard procedure for the resection of intraabdominal organs, including the stomach [1,2], gallbladder [3], spleen [4,5], colon [6,7], and kidney [8,9]
Minimally invasive pancreatoduodenectomy (MIPD), which includes laparoscopic pancreatoduodenectomy (LPD) and robotic pancreatoduodenectomy (RPD), remains limited by a lack of generalizability, and open surgery is preferred for pancreatic ductal adenocarcinoma (PDAC) due to concerns about adequate oncological outcomes and the potential for vessel resection
The number of patients undergoing preoperative biliary drainage and concurrent vessel resection was higher in the open pancreatoduodenectomy (OPD) group than in the minimally invasive pancreatoduodenectomy (MIPD)
Summary
Invasive surgery has become the standard of care for many surgical procedures across different specialties and is currently standard procedure for the resection of intraabdominal organs, including the stomach [1,2], gallbladder [3], spleen [4,5], colon [6,7], and kidney [8,9]. A Pan-European propensity score matched study was published that showed a comparable survival outcome when performing. Minimally invasive pancreatoduodenectomy (MIPD), which includes laparoscopic pancreatoduodenectomy (LPD) and robotic pancreatoduodenectomy (RPD), remains limited by a lack of generalizability, and open surgery is preferred for pancreatic ductal adenocarcinoma (PDAC) due to concerns about adequate oncological outcomes and the potential for vessel resection. Few studies have compared perioperative and oncological outcomes between minimally invasive pancreatoduodenectomy (MIPD) and open pancreatoduodenectomy (OPD) for pancreatic ductal adenocarcinoma (PDAC). Postoperative hospital stays were shorter for MIPD patients than OPD patients (12.4 vs 14.2 days, p = 0.040). The rate of overall complications and postoperative pancreatic fistula did not differ between the two groups. Conclusions: MIPD showed shorter postoperative hospital stays and comparable perioperative and oncological outcomes to OPD for selected PDAC patients. Future randomized studies will be required to validate these findings
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