title: Comparative effectiveness of minimally invasive and open distal pancreatectomy for ductal adenocarcinoma.
abstract: OBJECTIVE
  Multicenter studies indicate that outcomes of open (ODP) and minimally invasive distal pancreatectomy (MIDP) are equivalent for benign lesions. However, data for pancreatic carcinoma are limited.
  
  
  OBJECTIVE
  To compare outcomes of ODP and MIDP for early-stage pancreatic ductal carcinoma to determine relative safety and oncologic efficacy.
  
  
  METHODS
  Retrospective analysis of 62 consecutive patients undergoing ODP or MIDP for pancreatic ductal carcinoma by intention to treat with propensity scoring to correct for selection bias.
  
  
  METHODS
  A high-volume university center for pancreatic surgery.
  
  
  METHODS
  Sixty-two patients at a single institution.
  
  
  METHODS
  Patients underwent ODP or MIDP.
  
  
  METHODS
  Perioperative mortality, morbidity, readmission, postoperative complications, disease progression, and overall survival.
  
  
  RESULTS
  Thirty-four patients underwent ODP, and 28 underwent MIDP with 5 conversions to ODP. No significant differences in age, body mass index, performance status, tumor size, or radiographic stage were identified. High rates of margin-negative resection (ODP, 88%; MIDP, 86%) and median lymph node clearance (ODP, 12; MIDP, 11) were achieved in both groups with equal rates and severity of postoperative complications (ODP, 50%; MIDP, 39%) and pancreatic fistula (ODP, 29%; MIDP, 21%). Despite conversions, intended MIDP was associated with reduced blood loss (P = .006) and length of stay (P = .04). Conversion was associated with a poor histologic grade and positive nodes. Median overall survival for the entire cohort was 19 (95% CI, 14-47) months. Minimally invasive distal pancreatectomy was performed increasingly in later study years and for patients with a higher Charlson-Age Comorbidity Index. Overall survival after ODP or intended MIDP was equivalent after adjusting for comorbidity and year of surgery (relative hazard, 1.11 [95% CI, 0.47-2.62]).
  
  
  CONCLUSIONS
  We detected no evidence that MIDP was inferior to ODP based on postoperative outcomes or overall survival. This conclusion was verified by propensity score analysis with adjustment for factors affecting selection of operative technique.
authors: Department of Surgery, University of PittsburghMedical Center, Pittsburgh, Pennsylvania, USA.
authors: Deepa
authors: D
authors: Magge
authors: William
authors: W
authors: Gooding
authors: Haroon
authors: H
authors: Choudry
authors: Jennifer
authors: J
authors: Steve
authors: Jennifer
authors: J
authors: Steel
authors: Amer
authors: A
authors: Zureikat
authors: Alyssa
authors: A
authors: Krasinskas
authors: Mustapha
authors: M
authors: Daouadi
authors: Kenneth K W
authors: KK
authors: Lee
authors: Steven J
authors: SJ
authors: Hughes
authors: Herbert J
authors: HJ
authors: Zeh
authors: A James
authors: AJ
authors: Moser
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery*; D057186:Comparative Effectiveness Research; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D057216:Propensity Score; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome