Vascular Resection in Minimally Invasive vs Open Pancreaticoduodenectomy

Abstract

Introduction: Pancreaticoduodenectomy is associated with high morbidity and the complexity of the procedure increases with vascular resection. A growing body of evidence demonstrates the equivalence or benefit of minimally invasive pancreaticoduodenectomy (MIPD) when compared to open pancreaticoduodenectomy (OPD), regarding the short term outcomes and safety.The purpose of this study is to determine the postoperative outcomes of patients undergoing vascular resection with OPD or MIPD approach using a large, multicenter-cohort. Methods: All patients undergoing elective pancreaticoduodenectomy, including OPD and MIPD(robotic and laparoscopic,including open-assisted and unplanned open-conversion), with vascular resection in the ACS-NSQIP database (2014-2017) were included.Patient covariates and outcomes were compared using standard statistical methods. Results: 2233 (17.8%) patients underwent OPD with vascular resection and 149 (13.8%) patients underwent MIPD with vascular resection.The frequency of artery, vein, and combined artery and vein resection was (10.3%,69.9%, and 19.6%) in OPD and (16.1%,62.4%,and 21.47%) in MIPD, respectively.Patients undergoing MIPD vascular resection were more likely to have BMI< 25 (4.2%vs 42.5%, p-value=0.0143). The mean OR time was significantly longer in patients undergoing MIPD and vascular resection (485.4±13.30vs. 427±152.90, p-value< 0.0001). Patients undergoing OPD vascular resection were more likely to have postoperative sepsis (10.17%vs.4.70%, p-value=0.0299).There was a trend towards a decrease in superficial surgical site infection,organ space infection and length of stay and an increase in 30 day readmission in the MIPD vascular resection group. On multivariate analysis, postoperative sepsis was independently associated with OPD (p-value=0.0446). Conclusion: MIPD with vascular resection is safe and feasible. Future studies are needed to determine the effect of MIPD with vascular resection on long term outcomes and survival.