Laparoscopic Distal Pancreatectomy Research Articles

Laparoscopic distal pancreatectomy for intraductal papillary mucinous neoplasm-associated pancreatic cancer: A case report.

Introduction and importanceIntraductal papillary mucinous neoplasm (IPMN) of the pancreas is often found incidentally during examination for other diseases. In addition to the risk of malignant transformation, patients with IPMN are at risk of developing pancreatic cancer. We report a case of pancreatic tail cancer that developed separately from a preexisting IPMN after minimally invasive esophagectomy for cancer of the esophagogastric junction and was resected successfully by laparoscopic distal pancreatectomy.Case presentationA 72-year-old man underwent thoracoscopic and laparoscopic esophagectomy for esophagogastric junction cancer. He had undergone surgery for ascending colon cancer 20 years ago. At that time, IPMN was confirmed in the pancreatic body by a preoperative examination. Computed tomography was regularly performed for postoperative work-up and follow-up of the IPMN, and a solid lesion with cystic components was detected in the pancreatic tail 9 months after the operation. On detailed examination, pancreatic ductal adenocarcinoma concomitant with IPMN, accompanied by a retention cyst, was considered. Laparoscopic distal pancreatectomy was successfully performed after neoadjuvant chemotherapy. Pathological diagnosis of the lesion in the pancreatic tail was of an invasive intraductal papillary mucinous carcinoma (ypT3ypN0yM0 ypStageIIA).Clinical discussionIf an IPMN is detected during preoperative examination for malignancies of other organs, careful follow-up is necessary due to the high risk of pancreatic cancer development. Furthermore, initial operation with minimally invasive surgery may reduce adhesion and facilitate subsequent surgeries.ConclusionWe have provided evidence that supports the importance of a careful follow-up of IPMNs, even if they are low risk.

Quality of Life Instruments and Trajectories After Pancreatic Cancer Resection: A Systematic Review.

This systematic review aimed to investigate the instruments available to measure quality of life (QOL) after pancreatic cancer surgery and to describe short- and long-term QOL outcomes. A comprehensive literature search was completed using PubMed, Embase, and Medline from inception to March 2019. Studies investigating QOL outcomes in patients undergoing pancreatic cancer surgery who were 18 years or older were included. The main outcomes of interest were QOL instruments and short (≤6 months) and long term (>6 months) QOL outcomes. The overarching domains of physical, psychosocial, overall QOL, symptoms, and other were used to summarize QOL outcomes. Thirty-five studies reporting on 3573 patients were included. Fifteen unique QOL instruments were identified, of which 4 were disease-specific instruments. Most of the included studies reported no changes in QOL at short- and long-term follow-ups for the overarching domains. No difference in QOL outcomes was reported between different surgical approaches, except laparoscopic versus open distal pancreatectomy, and pancreaticoduodenectomy versus distal pancreatectomy. There are a wide range of instruments available to measure QOL outcomes in pancreatic cancer surgical patients, although only few are disease-specific. Most of the included studies reported no significant changes in QOL outcomes at short- or long-term follow-ups.

Surgical outcomes are hampered after endoscopic ultrasonography-guided ethanol lavage and/or Taxol injection in cystic lesions of the pancreas.

Backgrounds/AimsEndoscopic ultrasonography-guided ethanol lavage and Taxol injection (EUS-ELTI) for pancreatic cystic lesions have been recently performed in some medical centers. The aim of this study was to optimize patient selection and analyze outcomes of patients who underwent surgeries after EUS-ELTI for pancreatic cystic lesions.MethodsAmong 310 patients who underwent EUS-ELTI between January 2007 and December 2014, 23 underwent surgeries after EUS-ELTI owing to incomplete treatment and/or adverse events. Surgical outcomes of patients who underwent surgeries after EUSELTI were evaluated. Clinical outcomes of patients who underwent surgeries after EUS-ELTI were then retrospectively compared with those of patients who underwent upfront surgery for left-sided pancreatic lesions without an EUS-ELTI procedure.ResultsThe pathology revealed degenerated cysts in 12 patients, mucinous cyst neoplasms in five, neuroendocrine tumors in two, intraductal papillary mucinous neoplasm (IPMN) in one, solid pseudopapillary tumor in one, pancreatic ductal adenocarcinoma arising from an IPMN in one, and hepatoid carcinoma in one. Twelve patients underwent laparoscopic distal pancreatectomy and five patients underwent open distal pancreatectomy. When clinical outcomes were retrospectively compared between patients who underwent laparoscopic distal pancreatectomy after EUS-ELTI and those who did not receive an EUS-ELTI procedure, the spleen-preserving rate was 0% in the EUS-ELTI group and 61.7% (365/592) in the control group (p < 0.001).ConclusionsSurgical outcomes are compromised after EUS-ELTI for cystic tumor of the pancreas. Further studies are needed to investigate the efficacy and safety of the EUS-ELTI procedure.

A case of peripancreatic plexiform schwannoma

BackgroundPlexiform schwannoma is one of the least common variants of schwannoma, accounting for only 5% of all schwannoma cases. It generally occurs in the skin and subcutaneous tissues and is uncommon in deep soft tissue or viscera. We present an extremely rare case of plexiform schwannoma arising from the peripancreatic plexus.Case presentationA 29-year-old man presented with hyperglycemia detected during a medical checkup. He was diagnosed with type 1 diabetes based on the clinical findings and laboratory tests. During the diagnostic process for diabetes, a 2.5 cm mass was incidentally detected in the pancreas by abdominal ultrasound. Contrast-enhanced computed tomography revealed a mass that was gradually enhanced at the body and tail of the pancreas. Magnetic resonance imaging revealed low signal intensity of the mass on T1-weighted images and high signal intensity on T2-weighted and diffusion-weighted images. Magnetic resonance cholangiopancreatography showed no abnormal findings in the main pancreatic duct. Endoscopic ultrasonography (EUS) showed a lobulated, low-echoic mass with a clear boundary. EUS-guided fine needle biopsy was performed, and spindle-shaped cells that were diffusely immunopositive for S-100 and negative for c-kit and desmin were detected, resulting in a diagnosis of a neurogenic tumor arising from the pancreas or the peripancreatic nerve plexus. The patient underwent laparoscopic spleen-preserving distal pancreatectomy. Although the tumor was connected to the splenic plexus, the splenic artery could be divided along its adventitial plane. Macroscopic findings of the excised tumor consisted of multiple yellowish-white nodules, and its histopathological features were consistent with plexiform schwannoma. There was no pancreatic tissue on the dorsal surface of the tumor, which suggested that the tumor arose from the peripancreatic nerve plexus.ConclusionsThe findings documented herein can aid in the differential diagnosis of peripancreatic schwannoma and in planning appropriate treatment.

Short-Term Outcomes of the Tail-First Approach in Laparoscopic Spleen-Preserving Distal Pancreatectomy: a Single Center Experience

BackgroundSeveral approaches have been reported during laparoscopic spleen-preserving distal pancreatectomy (LSPDP), such as medial, lateral, and posterior approaches. This study reports a tail-first approach that is mobilization of the pancreatic gland from tail to neck followed by division. The short-term outcomes are described. MethodsCases which underwent LSPDP from 2014 to 2020 at Qilu Hospital of Shandong University were included. Clinical parameters were collected and analyzed. ResultsOne hundred five cases were collected, including 54 Kimura, 45 Warshaw, and 6 modified-Warshaw procedures. Seventy-seven patients (73.3%) underwent LSPDP by a tail-first approach (TFA-LSPDP) and 28 (26.7%) by a medial approach (M-LSPDP). Compared with the M-LSPDP, the TFA-LSPDP group had a lower incidence of splenic infraction (9.1 VS 25.0%, P = 0.05) and a higher frequency of Kimura procedure (55.8 VS 39.3%, P = 0.053). ConclusionTFA-LSPDP is feasible and safe for treatment of benign and low malignant lesions of the distal pancreas, which has a lower incidence of splenic infraction and a higher frequency of splenic vessel preservation compared with the traditional medial approach.

Assessment of difficulty in laparoscopic distal pancreatectomy: A modification of the Japanese difficulty scoring system - A single-center high-volume experience.

BackgroundThe Japanese difficulty scoring system (DSS) was developed to assess the difficulty of laparoscopic distal pancreatectomy (LDP). The study aimed to validate a modified DSS (mDSS) in a European high‐volume center.MethodsPatients' clinical data underwent LDP for benign and malignant pancreatic lesion between September 2013 and February 2020 were reviewed. Expert laparoscopic surgeons performed the procedures. The mDSS consisted of seven variables, such as type of operation, malignancy, neoadjuvant therapy, pancreatic resection line, tumor close to major vessels, tumor extension to peripancreatic tissue, and left‐sided portal hypertension and/or splenomegaly. According to the difficulty level and previous score, the mDSS was subdivided into three classes: low, intermediate, and high. Surrogates of case complexity (operative time, intraoperative blood loss and blood transfusion requirements, conversion rate) were used to validate the new scoring system.ResultsThe study population included 140 LDP. Ninety‐five (68%), 35 (25%) and 10 (7%) patients belonged to low, intermediate, and high difficulty groups. The mDSS identified the complexity of the surgical case of the series for all the surrogates of complexity considered, namely conversion rate (P = .004), operative time (P = .033) and intraoperative blood loss (P = .009). No differences were recorded in the postoperative outcomes (P > .05).ConclusionThe mDSS for LDP better stratified the pancreatic procedures according to their complexity. The new scoring system may allow an appropriate preoperative evaluation of surgical difficulty, facilitating LDP's training program. Future prospective studies are needed to validate the mDSS.

Efficacy of the slow firing method using a reinforced triple-row stapler for preventing postoperative pancreatic fistula during laparoscopic distal pancreatectomy.

Postoperative pancreatic fistula (POPF) remains the most clinically relevant complication of laparoscopic distal pancreatectomy (LDP). The present study evaluated the efficacy of the "slow firing method" using a reinforced triple-row stapler (Covidien, Tokyo, Japan) during LDP. This retrospective single-center study included 73 consecutive patients who underwent LDP using the slow firing method. A black cartridge was used in all patients. The primary endpoint was the rate of clinically relevant POPF (CR-POPF) after LDP. Secondary endpoints included perioperative outcomes and factors associated with CR-POPF as well as the correlation between the transection time and thickness of the pancreas. Four patients (5.5%) developed CR-POPF (grade B). Overall morbidity rates, defined as grade ≥ II and ≥ III according to the Clavien-Dindo classification, were 21 and 11%, respectively. The median postoperative hospital stay was 10days. Preoperative diabetes (13.6 vs. 0.2%, P = 0.044) and thickness of the pancreas ≥ 15mm (13.8% vs. 0%, P = 0.006) were identified as independent risk factors for CR-POPF. The median transection time was 16 (8-29)min. The slow firing method using a reinforced triple-row stapler for pancreatic transection is simple, safe, and effective for preventing CR-POPF after LDP.

Converted laparoscopic distal pancreatectomy: Is there an impact on patient outcome and total cost?

Converted laparoscopic distal pancreatectomy: Is there an impact on patient outcome and total cost?

Evaluation of factors predicting loss of benefit provided by laparoscopic distal pancreatectomy compared to open approach

Evaluation of factors predicting loss of benefit provided by laparoscopic distal pancreatectomy compared to open approach

Comparison of oncologic outcome between open versus laparoscopic distal pancreatectomy in patients with pancreatic ductal adenocarcinoma: Analysis with 1,202 patients in national database

Although the lack of high-level evidence, laparoscopic distal pancreatectomy (LDP) in pancreatic ductal adenocarcinoma (PDAC) is being performed by many surgeons due to the development of surgical techniques. The purpose of this study was to investigate the long-term oncologic outcomes of LDP in PDAC through propensity score matching (PSM) analysis with large-scale national database. Patients who received DP for PDAC registered in the official database of KAHBPS (KOTUS-BP) were enrolled. For long-term oncologic outcome analysis, 5-year overall survival rate (5YOSR) and 5-year disease-free survival rate (5YDFSR) were compared to open DP (ODP). From May 2001 to December 2016, 1,202 patients with detailed operative information and sufficient pathological data in 16 hospitals were selected. There were 846 ODP cases (70.4%) and 356 LDP cases (29.6%). In the ODP group, more aggressive surgery was performed, the pathologic stage was higher, R0 rate was higher (81.2% vs. 77.0%, p < 0.001) and there was a greater number of retrieved lymph nodes (15.3 vs. 13.5, p = 0.002) than the LDP group. PSM was performed with 8 variables including age, sex, operation period, combined organ resection, major vessel resection, R status, T stage, and N stage. After matching, the 5YOSR of ODP and LDP were 37.3% and 41.4% (p = 0.150), and 5YDFSR was 23.4% and 27.2% (p = 0.332), respectively. Prognostic factors for 5YOSR were R status, T stage, N stage, differentiation, and lymphovascular invasion. LDP was performed in a selected group, and within this group, it had comparable long-term oncologic outcome to ODP in patients with PDAC.

Validation of difficulty scoring system for laparoscopic distal pancreatectomy

Laparoscopic distal pancreatectomy (LDP) is gaining acceptance as a standard approach for removal of various benign and malignant pancreatic diseases. There are several methods of LDP which includes classic LDP with splenectomy for benign diseases, laparoscopic spleen and vessel preserving distal pancreatectomy, and laparoscopic radical pancreatectomy for invasive pancreatic cancers for pancreatic cancer. Several conditions may contribute to the difficulty of LDP based on type of operation, characteristics of the disease, patients' body habitus and tumor location. We have previously developed a difficulty scoring (DS) system to quantify the degree of difficulty in LDP to aid surgeons who would like to learn or teach this procedure in a stepwise manner. The aim of this study is to validate the DS system in LDP, proposed by the study group of Japan Society for Hepato-Biliary-Pancreatic Surgery/Asian-Pacific Hepato-Pancreato-Biliary Association in 2018 (J Hepatobiliary Pancreato Sci 2018;25:489-497). Effect of score assessed by DS system on surgical outcomes including conversion rate, operation time and blood loss was validated in both Korean and Japanese cohort. We found significant difference of operation time and conversion rates in both Japanese and Korean cohort. However, the DS was not related with blood loss in both cohorts. We observed associations between the DS system and operative outcomes, to some extent, and the trend seems to be same in both Korean and Japanese. To make the DS system for more useful one, we would like to modify the system in the future.

Splenic preservation versus splenectomy during laparoscopic distal pancreatectomy for benign and low-grade malignant pancreatic tumor: A propensity score matching analysis

Previous studies showed the advantages of spleen preservation during laparoscopic distal pancreatectomy (LDP) such as preventing overwhelming postsplenectomy infection, and early infectious complications, maintaining immune surveillance, less postoperative pancreatic fistula, less postpancreatectomy diabetes, and less gastric ileus. However, there were limitations of these results such as heterogenous population, and small number of patients. This study was aimed to compare clinical outcomes of patients with LDP with splenectomy (LDPS) and laparoscopic spleen preserving distal pancreatectomy (LSDP) using propensity score matching analysis from data of multi centers in Korea and Japan. The patients were identified who underwent LDPS and LSDP in Korea and Japan. Perioperative outcomes including postoperative infectious complication were compared between LDPS and LSDP before and after PSM. Matching variables were used such as nation, age, sex, BMI, ASA scores, underlying disease, previous abdominal surgery, preoperative pancreatitis, malignant disease and tumor locations. LDPS and LSDP were classified in 1,728 (39.6%), and 2,635 (60.4%), respectively. In the mean age and body mass index were 56.3 and 23.4. And 1,166 (26.7%) patients underwent previous abdominal surgery and tumor was located in body and tail in 2,041 (46.8%) and 2,290 (52.5%), respectively. Pancreas was transected at pancreas neck and tail level in 1,794 (41.1%) and 2,521 (57.8%), respectively. Splenic vessels were preserved in 1,244 (28.5%) of 2,635 patients with LSDP. Two hundred patients (4.6%) experienced conversion to open during surgery. Of patients, 1,303 (29.9%) patients experienced postoperative complications. Clinically related postoperative pancreatic fistula (CR-POPF) and infectious complication rates were 693 (15.3%) and 760 (17.4%) patients, respectively. After PSM, 1,594 patients were selected in each group. The patients with LSDP showed comparable overall complication (35.7 % vs. 38.4 %, p = 0.094), however LSDP group showed lower infectious complications (15.2 % vs. 19.1 %, p = 0.036), CR-POPF (13.7 % vs. 18.7 %, p < 0.001), infected POPF (5.7 % vs. 9.7 %, p < 0.001), complicated fluid collection (0.94% vs. 2.82%, p < 0.001) compared with the patients with LDP. The results of this study showed that LSDP was related with lower infectious complication rate including lower infected POPF, and lower complicated fluid collection compared with LDPS, and this result is helpful to decide splenic preservation in patients who needs LDP for pancreatic body or tail lesions.

Technical aspects in difficult laparoscopic distal splenopancreatectomy

Laparoscopic distal pancreatectomy is the gold standard nowadays. The infiltration of splenic artery near to its origin as well as engagement of splenic vein near to its confluence with superior mesenteric vein could be a reason for technical difficulties. In such cases the most easily accessible major landmark is the common hepatic artery. Transection of the pancreatic neck and splenic vein is essential to reach the dorsal aspect of the splenic artery at the level of the celiac trunk. The aim of this video is to present our approach to retroperitoneal access of the splenic artery. We present two cases of laparoscopic distal splenopancreatectomy, one of them for cancer of the pancreatic body, and the other one with pseudocyst of the pancreatic body. Mean age of the two patients was 59.5. Totally laparoscopic splenopancreatectomy with hepatoduodenal and celiac lymph node dissection was performed. Peripancreatic invasion near to the origin of the splenic artery was observed. Stepwise pancreatic transection at the neck, followed by transection of splenic vein were done in both cases. In the second one major venous bleeding occured and was managed by clipping and division of the splenic vein. The mean operative time was 240 minutes with insignificant blood loss. The patients had uneventful hospital stay and were discharged on the 7.5th postoperative day. Laparoscopic distal pancreatectomy can be technically difficult and should be performed only by surgeons with sufficient experience in both open pancreatic surgery and advanced laparoscopic gastrointestinal surgery.

Wrapping the pancreas with a polyglycolic acid sheet before stapling reduces the risk of fluid collection on the pancreatic stump after distal pancreatectomy

Postoperative pancreatic fistula (POPF) and postoperative fluid collection (POFC) are common complications after distal pancreatectomy (DP). The previous method of reducing the risk of POPF was the application of a polyglycolic acid (PGA) sheet to the pancreatic stump after cutting the pancreas with a stapler (After-stapling); the new method involves wrapping the pancreatic resection line with a PGA sheet before stapling (Before-stapling). The study aimed to compare the incidence of POPF and POFC between two methods. Data of patients who underwent open or laparoscopic DPs by a single surgeon from October 2010 to February 2020 in a tertiary referral hospital were retrospectively analyzed. POPF was defined according the updated International Study Group of Pancreatic Fistula criteria. POFC was measured by postoperative computed tomography (CT). Altogether, 182 patients were enrolled (After-stapling group, n = 138; Before-stapling group, n = 44). Clinicopathologic and intraoperative findings between the two groups were similar. Clinically relevant POPF rates were similar between both groups (4.3% vs. 4.5%, p = 0.989). POFC was significantly lesser in the Before-stapling group on postoperative day 7 (p < 0.001). Wrapping the pancreas with PGA sheet before stapling was a simple and effective way to reduce POFC.

Spleen-preserving distal pancreatectomy with vein scarifying and artery saving as an alternative for Warshaw method

There are two main laparoscopic spleen-preserving distal pancreatectomy (LSPDP) methods. One is the Kimura method that preserves both spleen artery and vein, which has advantage in sustained splenic perfusion but has technical difficulties. Another is the Warshaw method which sacrificed splenic vessels and has significant risks of splenic infarction or gastric varix. Herein, we introduce a modification of LSPDP that preserves splenic arteries at the expense of the splenic vein. From 2010 to 2019, patients who planned for LSPDP due to tumors in the body or tail of the pancreas were enrolled. We first used the Kimura method (group K), than depending on the extent of splenic vessel sacrifice, we categorized them as either being eligible for Warshaw method (group W) modified Warshaw method (group MW) if we preserved splenic artery and sacrificed only splenic vein. After surgery, we took imaging study every 3 months and then every 6 or 12 months, to assess the presence of gastric varices or splenic infarction. Eighty-six patients were analyzed (group K, 50; group W, 15; and group MW, 21). The surgery took longer in group K than it did in either group W or group MW. The incidence of splenic infarction was lower in group MW than in group W (p = 0.035). The incidence of gastric varices or splenomegaly was no difference between group MW and group W. The MW method could serve as one of the LSPDP modalities that improve on the disadvantages of conventional LSPDP techniques.

Initial experience of robotic single port plus one (SP + 1) distal pancreatectomy using the da Vinci SP system: A report of three cases with video

With the advances of laparoscopic techniques, many efforts to reduce the number of the trocar site in abdominal surgery has been made. However, laparoscopic single-site distal pancreatectomy is regarded as difficult and technically demanding. Robotic surgical system was introduced to overcome the limitation of conventional laparoscopic surgery. The da Vinci surgical system released its new pure single-port platform, the da Vinci SP, offering improvements and refinements for established robotic single-site procedures. We report our initial experience of robotic single port plus one port (SP + 1) distal pancreatectomy using the da Vinci SP system. To our knowledge, this is the first report in Korea using the da Vinci SP system for distal pancreatectomy. We reviewed the medical records of three patients in whom robotic single port plus one port (SP + 1) distal pancreatectomy was carried out. Robotic distal pancreatectomy was performed using the da Vinci SP system with one additional port. An additional robotic 12-mm-port was placed on the left side of the da Vinci SP system and was used for applying energy device such as Thunderbeat and endo-GIA stapling. The median age was 70 years (range 65-77). Pathological diagnosis included pancreas serous cystadenoma, neuroendocrine tumor and unsuspected pancreatic cancer. Median operation time was 245 minutes (range 135-265 minutes). All patients underwent combined splenectomy. There was no clinically relevant postoperative pancreatic fistula. Length of hospital stay was median 10 days after surgery. Robotic single port distal pancreatectomy using the da Vinci SP system is safe and feasible with acceptable perioperative outcomes.

Laparoscopic Pancreatectomy in Rats: The Development of an Experimental Model

Introduction several pancreatectomy techniques in rats have been described and utilized for research concerning the pancreas endocrine and exocrine functions. However, we did not find a description of any kind of laparoscopic pancreatectomy in rats in the consulted databases. The objective of this study is to describe a laparoscopic splenic lobe pancreatectomy in rats. Methods ten Wistars rats weighting more then 300 g were operated for standardizing the laparoscopic pancreatosplenectomy technique, aided by previous descriptions of laparoscopic splenectomy and open pancreatectomy in rats. Adjustments have been progressively adopted for technical refinement. Results In five animals a low-cost rat laparoscopic set was used. In other five animals we used a standard laparoscopic set. Three rats died early due to different causes: transection of the gastroesophageal junction, hemorrhagic shock and inadvertent colonic injury. The postoperative period of the other seven rats was uneventful until the seventh postoperative day. Discussion laparoscopic distal pancreatectomy and splenectomy in rats is feasible and safe, even with a low-cost set, in which the results were alike the standard laparoscopic set.

ASO AUTHOR REFLECTIONS: Laparoscopic DistalPancreatectomy for Pancreatic Cancer: Good, Bad, or Even Ugly?

ASO AUTHOR REFLECTIONS: Laparoscopic DistalPancreatectomy for Pancreatic Cancer: Good, Bad, or Even Ugly?

Robotic versus laparoscopic distal pancreatectomies: Asystematic review and meta-analysis on costs and perioperative outcome.

The aim of this meta-analysis is to compare perioperative outcomes and costs of robotic and laparoscopic distal pancreatectomy (RDP and LDP). In accordance with the PRISMA guidelines, we searched Medline, EMBASE, Cochrane and Web of Science for reports published before December 2020. The literature search identified 11 papers (1 187 patients). RDP showed a lower conversion rate (odds ratio: 2.56, 95% confidence intervals [CI]: 1.31 to 5.00) with no significant differences in bleeding and operative time, complications≥Clavien-Dindo grade III, pancreatic fistulas and length of stay. Despite RDP presenting higher costs in all included studies, none of these differences were significant. However, RDP showed higher total costs than LDP (standardized mean differences [SMD]: -1.18, 95% CI: -1.97 to -0.39). A subgroup analysis according to the continent of origin showed that studies coming from Asian research groups kept showing significant differences (SMD: -2.62, 95% CI: -3.38 to -1.85), while Western groups did not confirm these findings. Based on low-quality evidence, despite some potential technical advantages, RDP still seems to be costlier than LDP.

Does a Laparoscopic Approach to Distal Pancreatectomy for Cancer Contribute to Optimal Adjuvant Chemotherapy Utilization?

Although laparoscopic distal pancreatectomy (LDP) versus open approaches (ODP) for pancreatic adenocarcinoma (PDAC) is associated with reduced morbidity, its impact on optimal adjuvant chemotherapy (AC) utilization remains unclear. Furthermore, it is uncertain whether oncologic resection quality markers are equivalent between approaches. The National Cancer Database (NCDB) was queried between 2010 and 2016 for PDAC patients undergoing DP. Effect of LDP vs ODP and institutional case volumes on margin status, hospital stay, 30-day and 90-day mortality, administration of and delay to AC, and 30-day unplanned readmission were analyzed using binary and linear logistic regression. Cox multivariable regression was used to correct for confounders. The search yielded 3411 patients; 996 (29.2%) had LDP and 2415 (70.8%) had ODP. ODP had higher odds of readmission [odds ratio (OR) 1.681, p = 0.01] and longer hospital stay [β 1.745, p = 0.004]. No difference was found for 30-day mortality [OR 1.689, p = 0.303], 90-day mortality [OR 1.936, p = 0.207], and overall survival [HR 1.231, p = 0.057]. The highest-volume centers had improved odds of AC [OR 1.275, p = 0.027] regardless of approach. LDP conferred lower margin positivity [OR 0.581, p = 0.005], increased AC use [3rd quartile: OR 1.844, p = 0.026; 4th quartile; OR 2.144, p = 0.045], and fewer AC delays [4th quartile: OR 0.786, p = 0.045] in higher-volume centers. In selected patients, LDP offers an oncologically safe alternative to ODP for PDAC independent of institutional volume. However, additional oncologic benefit due to optimal AC utilization and lower positive margin rates in higher volume centers suggests that LDP by experienced teams can achieve best possible cancer outcomes.