Reduced morbidity with minimally invasive distal pancreatectomy for pancreatic adenocarcinoma.
Minimally invasive distal pancreatectomy (MISDP) has been shown to be safe relative to open distal pancreatectomy (ODP). However, MISDP has been slow to adopt for pancreatic adenocarcinoma (PDAC). This study sought to compare outcomes following MISDP vs. ODP for PDAC.



Data were prospectively collected from 2011 to 2014 for DP by the American College of Surgeons-National Surgical Quality Improvement Program. Patients without PDAC on surgical pathology were excluded. Impact of minimally invasive approach on morbidity and mortality was analyzed using two-way statistical analyses.



Of 6198 patients undergoing DP, 501 (7.5%) had a pathologic diagnosis of PDAC. MISDP was undertaken in 166 (33.1%) patients, ODP was performed in 335 (66.9%). MISDP and ODP were not different in preoperative comorbidities or pathologic stage. Overall morbidity (MISDP 31%, ODP 42%; p = 0.024), transfusion (MISDP 6%, ODP 23%; p = 0.0001), pneumonia (MISDP 1%, ODP 7%; p = 0.004), surgical site infections (MISDP 8%, OPD 17%; p = 0.013), sepsis (MISDP 2%, ODP 8%; p = 0.007), and length of stay (MISDP 5.0 days, ODP 7.0 days; p = 0.009) were lower in the MIS group. Mortality (MISDP 0%, ODP 1%; p = 0.307), pancreatic fistula (MISDP 12%, ODP 19%; p = 0.073), and delayed gastric emptying (MISDP 3%, ODP 7%; p = 0.140) were similar.



This analysis of a large multi-institution North American experience of DP for treatment of pancreatic adenocarcinoma suggests that short-term postoperative outcomes are improved with MISDP.
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Anastasia
A
Plotkin
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA. Electronic address: eceppa@iupui.edu.
Eugene P
EP
Ceppa
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Ben L
BL
Zarzaur
Indiana University Health University Hospital, Indiana University Health, Indianapolis, IN, USA.
Elizabeth M
EM
Kilbane
Department of Surgery, University of Arizona, Tucson, AZ, USA.
Taylor S
TS
Riall
Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
Henry A
HA
Pitt
D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D008297:Male; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome; D014481:United States