Equal Access for Minimally Invasive Pancreaticoduodenectomy

Abstract

INTRODUCTION: Minimally invasive pancreaticoduodenectomy (MIPD) is more frequently employed in the management of pancreatic malignancies and offers potential advantages over open pancreatoduodenectomy (OPD) in length of stay, time to adjuvant therapy, and margin status. Whether disparities in access to MIPD exist is less clear. METHODS: The National Cancer Database (NCDB) was queried (2010 to 2017) for patients who underwent pancreatoduodenectomy (PD) for pancreatic malignancy. Cochran-Armitage tests were employed to assess for trends over time. Social determinants of health were compared between OPD and MIPD, including insurance status, region, race, income, and education. Multivariable logistic models identified predictors of MIPD. RESULTS: We identified 12,639 patients, of which 81.3% (n = 10,274) were OPD and 18.7% (n = 2,365) were MIPD (18.4% robotic/81.6% laparoscopic). For all patients, the proportion of cases that were robotic (1.7% vs 5.5%) and laparoscopic (11.4% vs 16.8%) increased over time (p < 0.0001). Patients with pancreatic adenocarcinoma were less likely to have MIPD if they were Black (vs White; odds ratio [OR] 0.75; 95% CI 0.62 to 0.90) or if they had ≥21% no high school degree (vs <7% no high school degree OR 0.70; 95% CI 0.57 to 0.87). Over time, MIPD increased as a proportion of all PD performed for White patients (p < 0.0001), and the proportion for Black patients was unchanged (p = 0.125). CONCLUSION: Patients who are Black or have lower educational status are less likely to undergo MIPD compared with OPD. Proportion of MIPD is increasing over time for White patients, but not for Black patients. These data may suggest that the racial gap in access to MIPD could continue to widen.