Surgical approach to pancreaticoduodenectomy for pancreatic adenocarcinoma: uncomplicated ends justify the means.

Abstract

BACKGROUND:

Pancreaticoduodenectomy (PD) remains the cornerstone of managing pancreatic ductal adenocarcinoma (PDAC) of the pancreas head/neck, but it is associated with high morbidity. We hypothesize that, in absence of pancreatectomy-specific morbidity (PSM), minimally invasive PD (MIPD) provides improved short-term outcomes compared to open PD (OPD).

METHODS:

NSQIP pancreatectomy-targeted database 2014-2019 was utilized. PSM was defined as the occurrence of delayed gastric emptying (DGE) and/or post-operative pancreatic fistula (POPF). The cohort was divided into No-PSM and PSM groups. Propensity score match was applied in each group to compare outcomes of MIPD vs. OPD.

RESULTS:

8,121 patients were selected. Patients were divided into No-PSM (N = 6267) and PSM (N = 1854) groups. In No-PSM group, we matched 1656 OPD to 552 MIPD patients. MIPD had longer operations (423 vs. 359 min; p < 0.001) but less overall morbidity (22.1% vs. 29.1%; p = 0.001) mostly attributed to less bleeding and sepsis. MIPD patients also had a one-day shorter median LOS (6 vs. 7 days; p = 0.005) and higher rates of home discharge (92.8% vs. 89.6%; p = 0.027). No difference was noted in mortality and 30-day readmission. In PSM group, 441 OPD were matched to 147 MIPD peers. MIPD had longer operations but without short-term benefits. General morbidity (61.2% vs. 61.9%), median LOS (12 vs. 12 days), mortality (2.7% vs. 1.8%), and readmission rates (32.7% vs. 26.5%) were similar. Same conclusions were drawn in the per-protocol analysis.

CONCLUSION:

PSM is common following PD for PDAC. In the absence of PSM, MIPD is associated with less postoperative morbidity and shorter LOS.

• Authors: Samer A Naffouje, David T Pointer Jr, Megan A Satyadi, Pamela Hodul, Daniel A Anaya, Jose Pimiento, Mokenge Malafa, Dae Won Kim, Jason B Fleming, Jason W Denbo
• Journal: Surgical endoscopy (Surg Endosc) Vol. 36 Issue 7 Pg. 4912-4922 (07 2022) ISSN: 1432-2218 [Electronic] Germany
• PMID: 34859301 (Publication Type: Journal Article)
• Copyright: © 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Topics

• Adenocarcinoma (complications)
• Carcinoma, Pancreatic Ductal (surgery)
• Humans
• Laparoscopy (adverse effects)
• Pancreatectomy (adverse effects)
• Pancreatic Neoplasms (pathology)
• Pancreaticoduodenectomy (methods)
• Postoperative Complications (epidemiology, etiology, surgery)
• Retrospective Studies
• Pancreatic Neoplasms