K. L. Anderson1, M. A. Adam2, S. Thomas3, S. A. Roman2, J. A. Sosa2,4 1Duke University School Of Medicine,Durham, NC, USA 2Duke University Medical Center,Department Of Surgery,Durham, NC, USA 3Duke University,Department Of Biostatistics,Durham, NC, USA 4Duke Clinical Research Institute,Durham, NC, USA
Introduction: Interest in minimally invasive distal pancreatectomy (MIDP) has increased. Published data examining impact of MIDP on survival are limited to experiences from high-volume institutions. Our aims were to compare adjuvant chemotherapy use and overall survival between MIDP and open surgery (ODP).
Methods: Adult patients undergoing distal pancreatectomy for Stage I and II pancreatic adenocarcinoma were identified from the National Cancer Data Base, 2010-2012. Univariate and multivariate regression and survival analysis were employed to examine the association between MIDP (laparoscopic or robotic) vs. ODP and use of adjuvant chemotherapy and oncologic outcomes.
Results: A total of 1,807 patients underwent distal pancreatectomy for adenocarcinoma at 506 institutions: 505 (28%) MIDP, and 1,302 (72%) ODP. Use of MIDP from 2010 to 2012 increased from 131 (26%) to 209 (41%) cases. The majority of MIDP cases were performed at academic institutions (68%) compared to comprehensive community (30%) and community hospitals (2%). After adjustment, compared to patients who underwent ODP, those who underwent MIDP were more likely to have complete tumor resections [OR 1.53 (CI 1.09-2.17), p=0.02] and a shorter hospital length of stay (LOS) [-11%, (CI -5% to -16%), p=0.0002]. MIDP is associated on average with an 11% shorter LOS, which would be a reduction of about 1 day from the average ODP LOS of 10 days. The rates of 30-day readmission [OR 1.11 (0.72-1.72), p=0.62] and 30-day mortality [OR 0.83 (0.65-1.06), p=0.13] were similar between groups. Patients undergoing MIDP vs. ODP were more likely to receive adjuvant chemotherapy [OR 1.26 (1.00-1.60), p=0.05]; time to initiation of adjuvant chemotherapy was not different between groups [-2%, (CI -8% to 4%) p=0.45). Median follow-up was 17 months (IQR 10-26 months). In unadjusted analysis, 3-year survival was similar between MIDP and ODP (40% vs. 37%, p=0.42). After adjustment, overall survival for MIDP vs. ODP remained similar (HR 0.85, (CI 0.67-1.10) p=0.21).
Conclusion: Over the years, utilization of MIDP has increased, with the majority of procedures performed at academic institutions. It is associated with increased use of adjuvant chemotherapy; further study is needed to understand the etiology and impact of this association.