Presenter: Roheena Panni MD, MPHS | Washington University, St. Louis Background: Pancreaticoduodenectomy is associated with high morbidity and the complexity of the procedure increases with vascular resection. Vascular resection during pancreaticoduodenectomy is associated with increased operative time, perioperative transfusion, DVT, septic shock, and length of stay, but the overall mortality is similar. With the advancement in minimally invasive surgical techniques, laparoscopic and robotic pancreatic surgery is becoming more common. A growing body of evidence exists demonstrating 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 were included in the study. Patients were stratified into those who underwent OPD vascular resection and those who underwent MIPD vascular resection. Patient covariates and outcomes were compared using standard statistical methods. Results: 2233 patients underwent OPD with vascular resection (17.8%) and 149 patients underwent MIPD with vascular resection (13.8%). 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 (34.2% vs 42.5%, p-value 0.0143). The mean OR time was significantly longer in patients undergoing MIPD and vascular resection compared to OPD and vascular resection (485.4 ± 13.30 vs. 427 ± 152.90, p-value < 0.0001). We next compared postoperative complications and found that patients undergoing OPD vascular resection were more likely to have postoperative sepsis compared to MIPD vascular resection (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; however, these differences were not statistically significant. 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.