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. 2023 Apr;225(4):728-734.
doi: 10.1016/j.amjsurg.2022.10.056. Epub 2022 Oct 28.

Discrepancies in survival after conversion to open in minimally invasive pancreatoduodenectomy

Anthony M Villano  1 , Karen Ruth  2 , Jason Castellanos  3 , Jeffrey M Farma  3 , Sanjay S Reddy  3
Affiliations

Discrepancies in survival after conversion to open in minimally invasive pancreatoduodenectomy

Anthony M Villano et al. Am J Surg. 2023 Apr.

Abstract

Background: The extent by which conversion to open (CTO) during minimally invasive procedures for pancreatic cancer impact survival outcomes is not fully understood.

Methods: The 2010-2017 National Cancer Database identified 12,424 non-metastatic patients who underwent pancreatoduodenectomy for ductal adenocarcinoma. Patients were stratified into three cohorts: open (OPD), completed MIPD (cMIPD), and CTO. Subgroups were dichotomized by hospital MIPD volume.

Results: Across the study period, 80.6% of patients underwent OPD, 19.4% MIPD, and 24% were CTO. Median overall survival was worse after CTO (21.8 months) than for OPD (23.6 months) or cMIPD (25.2 months) (p < 0.001). Although this effect persisted for <10 MIPD/year, CTO did comparably to OPD at hospitals performing ≥10MIPD/year (CTO = 26.8 months, OPD = 27.9 months; p = 0.128). Ninety-day mortality after CTO was worse at ≤ 10 MIPD/year hospitals (9.3% vs. 2.6%).

Conclusions: Short and long-term survival is impacted by CTO after MIPD, especially at lower surgical volumes, stressing careful adoption while ascending the learning curve.

Keywords: Cancer; Conversion; Minimally invasive; Outcomes; Pancreas; Survival.

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Conflict of interest statement

Declaration of competing interest None.

Figures

Figure 1.
Figure 1.
STROBE diagram illustrating construction of the analytic cohort using the 2004-2017 NCDB pancreas dataset.
Figure 2.
Figure 2.
Trends in MIPD utilization and CTO overall, and amongst laparoscopic and robotic approaches. A) Histogram depicting the distribution of MIPD volume by annual hospital surgical volume. B) Distribution of PD volume by approach, stratified by annual hospital surgical volume (<10 MIPD/year, blue bar and ≥10 MIPD/year, red bar). C) Trends in trends in MIPD utilization (blue bars) and conversions to open (red trendline) overall. D) Rates of CTO by annual hospital surgical volume. Blue trendline = <10 MIPD/year; Red Trendline = ≥ 10MIPD/year.
Figure 3.
Figure 3.
Median overall survival amongst OPD, cMIPD, and CTO analytic cohorts A) overall, B) facilities performing <10MIPD/year, C) facilities performing ≥10MIPD/year
See this image and copyright information in PMC

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