M. Abdelgadir Adam1, K. Choudhury3, M. Dinan2, S. Reed2, R. Scheri1, D. Blazer1, S. Roman1, J. Sosa1,2 1Duke University Medical Center,Surgery,Durham, NC, USA 2Duke Clinical Research Institute,Durham, NC, USA 3Duke University Medical Center,Biostatistics,Durham, NC, USA
Introduction: Emerging data from high-volume institutions suggest that minimally invasive distal pancreatectomy (MIDP) provides favorable perioperative outcomes and adequate oncologic resection. However, it is unclear if these outcomes are generalizable at a population level. This study examines patterns of use and short-term outcomes from MIDP vs. open distal pancreatectomy for pancreatic cancer.
Methods: Adult patients undergoing distal pancreatectomy were identified from the National Cancer Database, 2010-2011. Descriptive statistics were used to characterize patterns of laparoscopic and/or robotic MIDP use. Multivariable modeling was applied to determine factors associated with use of MIDP and compare short-term outcomes from MIDP vs. open surgery, while adjusting for patient, clinical, and tumor characteristics.
Results: A total of 1,733 patients underwent distal pancreatectomy for cancer: 535 had MIDP and 1,198 had open surgery. Use of MIDP increased 43% between 2010 to 2011, from 220 to 315 cases. Across both study years, the conversion rate from MIDP to open distal pancreatectomy was 23%. MIDP cases were performed at 215 hospitals, with the overwhelming majority of hospitals (97%) performing <10 cases overall. The majority of MIDP cases (67%) were performed at academic institutions. Patients were more likely to undergo MIDP if they were older [odds ratio (OR) 1.02 (95% confidence interval (CI) 1.01-1.04), p<0.01], privately insured [OR 1.41 (CI 1.04-1.92), p=0.03], diagnosed in 2011 (vs. 2010) [OR 1.48 (CI 1.17-1.86), p<0.01], or had a diagnosis of a neuroendocrine malignancy (vs. adenocarcinoma) [OR 1.82 (CI 1.37-2.40), p<0.01]. After adjustment, compared to the open group, those who underwent MIDP were more likely to have negative surgical margins [OR 1.66 (CI 1.12-2.46), p=0.01] and a shorter length of stay [relative risk (RR) 0.82 (0.76-0.89), p<0.01]; the number of lymph nodes removed [RR 0.94 (0.85-1.04), p=0.24], rates of 30-day readmission [OR 1.15 (0.72-1.83), p=0.57] and 30-day mortality [OR 0.34 (0.06-1.80), p=0.20] were similar between groups.
Conclusion: Use of MIDP for cancer is increasing, with most centers performing a low volume of these procedures. Use of MIDP for body and tail malignancies of the pancreas appears to have short-term outcomes that are similar to those of open procedures with the benefit of a shorter length of hospital stay. Larger studies with longer follow-up should be undertaken to examine clinical outcomes.