Outcomes of Minimally Invasive Distal Pancreatectomy in the Octogenarian Population: An ACS NSQIP Analysis

Abstract

Introduction: Minimally invasive distal pancreatectomy (MIDP) has become increasingly used in practice. Multiple studies have shown improvements in estimated blood loss (EBL), length of stay (LOS) and decreased complication rates. We aim to evaluate the impact of operative approach on postoperative outcomes in octogenarians undergoing distal pancreatectomy. Method: Elective non-emergent distal pancreatectomies (DPs) were identified from the 2014–2019 ACS-NSQIP Procedure Targeted Pancreatectomy Participant Use Data Files. Outcomes examined included: mortality, major complications, minor complications, postoperative pancreatic fistula (POPF), clinically relevant postoperative pancreatic fistula (CR-POPF), prolonged postoperative length-of-stay (P-LOS), and Non-home discharge (NHD). Outcomes were compared between open (ODP) and MIDP groups. Multivariable logistic regression models were constructed to examine the risk-adjusted impact of approach on outcomes. Results: Of 9,681 elective DPs, only 634 were octogenarians. Of these, 330 were ODP and 332 MIDP (87, 26.2% were robotic). The MIDP group was less likely to have greater than 10% weight loss (5.12% vs 11.33%, p=0.015), to have received preoperative chemotherapy (6.93% vs 15%, p=0.02), preoperative radiation (1.81% vs 7%, p=0.03) and to have had pancreatic adenocarcinoma (51.81% vs 54.33%, p<0.001). On univariable analysis, MIDP had lower incidence of major complications (5.52% vs 8.33%, p=0.02) and P-LOS (19.58% vs 36.67%, p<0.001). On multivariable analysis, MIDP remained independently predictive of a lesser rate of P-LOS (OR: 0.39, P<0.001). Conclusions: MIPD was independently predictive of shorter LOS in octogenarians. MIDP is a safe and effective approach in this frail population.Tabled 1Table 1. Multivariable Model for Prolonged Length of Stay (>7days)PredictorOdds Ratio95% C.I.P-valueMIDP0.390.27-0.57<0.001COPD2.891.25-6.670.01310% Weight Loss0.80.41-1.550.517Preoperative Chemotherapy0.750.38-1.510.431Preoperative Radiotherapy1.310.48-3.540.585Pancreatic adenocarcinoma1.360.93-1.970.104 Open table in a new tab