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Multicenter Study
. 2022 Oct;36(10):7302-7311.
doi: 10.1007/s00464-022-09111-2. Epub 2022 Feb 17.

Minimally invasive vs open pancreatoduodenectomy on oncological adequacy: a propensity score-matched analysis

Yazan Ashouri  1 , Katherine Ho  2 , Helen Ho  1 , Chiu-Hsieh Hsu  3 , Iman Ghaderi  2 , Taylor S Riall  2 , Ioannis T Konstantinidis  4 , Felipe B Maegawa  5
Affiliations
Multicenter Study

Minimally invasive vs open pancreatoduodenectomy on oncological adequacy: a propensity score-matched analysis

Yazan Ashouri et al. Surg Endosc. 2022 Oct.

Abstract

Background: The adoption of minimally invasive pancreatoduodenectomy (MIPD) has increased over the last decade. Most of the data on perioperative and oncological outcomes derives from single-center high-volume hospitals. The impact of MIPD on oncological outcomes in a multicenter setting is poorly understood.

Methods: The National Cancer Database was utilized to perform a propensity score matching analysis between MIPD vs open pancreatoduodenectomy (OPD). The primary outcomes were lymphadenectomy ≥ 15 nodes and surgical margins. Secondary outcomes were 90-day mortality, length of stay, and overall survival.

Results: A total of 10,246 patients underwent pancreatoduodenectomy for ductal adenocarcinoma between 2010 and 2016. Among these patients, 1739 underwent MIPD. A propensity score matching analysis with a 1:2 ratio showed that the rate of lymphadenectomy ≥ 15 nodes was significantly higher for MIPD compared to OPD, 68.4% vs 62.5% (P < .0001), respectively. There was no statistically significant difference in the rate of positive margins, 90-day mortality, and overall survival. OPD was associated with an increased rate of length of stay > 10 days, 36.6% vs 33% for MIPD (P < .01). Trend analysis for the patients who underwent MIPD revealed that the rate of adequate lymphadenectomy increased during the study period, 73.1% between 2015 and 2016 vs 63.2% between 2010 and 2012 (P < .001). In addition, the rate of conversion to OPD decreased over time, 29.3% between 2010 and 2012 vs 20.2% between 2015 and 2016 (P < .001).

Conclusion: In this propensity score matching analysis, the MIPD approach was associated with a higher rate of adequate lymphadenectomy and a shorter length of stay compared to OPD. The surgical margins status, 90-day mortality, and overall survival were similar between the groups.

Keywords: Lymphadenectomy; Minimally invasive; Pancreatoduodenectomy; Propensity score matching.

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