Improved Outcomes with Minimally Invasive Pancreaticoduodenectomy in Patients with Dilated Pancreatic Ducts: A Prospective Study

Abstract

Introduction: Little is known about what predicts better outcomes for minimally invasive pancreaticoduodenectomy (MIPD) versus open pancreaticoduodenectomy (OPD). We hypothesized that MIPD patients with dilated pancreatic ducts have improved outcomes compared to OPD. Methods: All patients undergoing pancreaticoduodenectomy were prospectively followed over 47 months; perioperative and pathologic covariates and outcomes were compared. Ideal outcome (IO) was defined as: having no complications, postoperative length of stay < 7 days and negative margins on pathology. Patients with dilated ducts (≥3mm) who underwent MIPD were 1:3 propensity score matched to patients with dilated ducts who underwent OPD. Likewise, patients with non-dilated ducts (<3mm) who underwent MIPD were 1:3 propensity score matched to patients with non-dilated ducts who underwent OPD, and outcomes compared. Results: 371 patients underwent PD– 74 (19.9%) MIPD and 297 (80.1%) OPD. Overall, MIPD patients had significantly less intraoperative blood loss. After 1:3 propensity score matching, MIPD patients with dilated pancreatic ducts (n=45) had significantly lower overall complication and 90-day readmission rates compared to matched OPD patients (n=135) with dilated ducts. MIPD patients with dilated duct were more likely to have IO than patients with OPD (29% vs 15%, p=0.035). There were no significant differences in postoperative outcomes among matched patients with non-dilated pancreatic ducts who underwent MIPD (n=29) compared to matched patients undergoing OPD (n=87) with non-dilated ducts. Conclusions: MIPD is safe with comparable outcomes to OPD. Patients with pancreatic ducts ≥3mm derive the most benefit from MIPD: fewer complications, lower readmission rates and higher likelihood of ideal outcome.