Current Trends in Pancreatoduodenectomy: A NSQIP Study

Abstract

Introduction: Pancreaticoduodenectomy (PD) remains one of the most challenging and complex surgical procedures, with high morbidity rates, prolonged hospital length of stay (LOS), and high resource use. With continued evolution in treatment and peri-operative care plans, this study aimed to evaluate trends in preoperative and operative factors and postoperative surgical outcomes after PD over a 7-year period (2014-2020). Methods: The American College of Surgeons NSQIP pancreas-targeted database was queried to identify patients with pancreatic malignancy who underwent PD from 2014 to 2020. Trends in patient demographics, operative factors, and postoperative outcomes were computed and analyzed using the Jonckheere-Terpstra trend test. Results: A total of 13,933 pancreatic cancer patients who underwent PD were included. From 2014 to 2020, patients older than 65 years increased from 56.0% to 60.6%, non-White patients increased by 2.54% (mainly in Asian patients), and the rate of neoadjuvant chemotherapy increased by 26.6%(p < 0.001). Significant trends in operative factors include an increase in minimally invasive surgery (MIS) approach from 6.4% to 9.4% (p < 0.001) and vascular resection from 22.1% to 26.3% (p < 0.001). Postoperative early discharge (<5 days) increased from 10.4% to 24.0% (p < 0.001), while the rates of pancreatic fistula and complication of any type decreased from 12.7% to 6.9% and 40.9% to 35.7% respectively (p < 0.001). Conclusion: Over this recent 7-year period evaluated time, significant changes have occurred in demographics, operative factors, and outcomes of patients undergoing PD for pancreatic cancer. Understanding the evolving nature of PD conduct and outcome is relevant to comprehending this population’s needs, characteristics, and perioperative planning.