Minimally Invasive Versus Open Pancreaticoduodenectomy

Ibrahim Nassour, Sam C. Wang, Alana Christie, Mathew M. Augustine, Matthew R. Porembka, Adam C. Yopp, Michael A. Choti, John C. Mansour, Xian Jin Xie, Patricio M. Polanco, Rebecca M. Minter

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Objective: To compare the perioperative outcomes of minimally invasive pancreaticoduodenectomy (MIPD) in comparison with open pancreaticoduodenectomy (OPD) in a national cohort of patients. Background: Limited well-controlled studies exist comparing perioperative outcomes between MIPD and OPD. Methods: Patients who underwent MIPD and OPD were abstracted from the 2014 to 2015 pancreas-targeted American College of Surgeons National Surgical Quality Improvement Program. OPD and MIPD patients were matched 3:1 using propensity score, and perioperative outcomes were compared. Results: A total of 4484 patients were identified with 334 (7.4%) undergoing MIPD. MIPD patients were younger, more likely to be White, and had a lower rate of weight loss. They were more likely to undergo classic Whipple and to have a drain placed. After 3:1 matching, 1002 OPD patients were compared with 334 MIPD patients. MIPD was associated with longer mean operative time (426.6 vs 359.6 minutes; P < 0.01), higher readmission rate (19.2% vs 14.3%; P = 0.04) and lower rate of prolonged length of stay >14 days (16.5% vs 21.6%; P = 0.047). The 2 groups had a similar rate of 30-day mortality (MIPD 1.8% vs OPD 1.3%; P = 0.51), overall complications, postoperative pancreatic fistula, and delayed gastric emptying. A secondary analysis comparing MIPD without conversion or open assist with OPD showed that MIPD patients had lower rates of overall surgical site infection (13.4% vs 19.6%; P = 0.04) and transfusion (7.9% vs 14.4%; P = 0.02). Conclusions: MIPD had an equivalent morbidity and mortality rate to OPD, with the benefit of a decreased rate of prolonged length of stay, though this is partially offset by an increased readmission rate.

Original languageEnglish (US)
Pages (from-to)151-157
Number of pages7
JournalAnnals of Surgery
Volume268
Issue number1
DOIs
StatePublished - Jul 1 2018

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Pancreaticoduodenectomy
Pancreatic Fistula
Surgical Wound Infection
Propensity Score

Keywords

  • laparoscopic
  • minimally invasive
  • pancreaticoduodenectomy
  • robotic

ASJC Scopus subject areas

  • Surgery

Cite this

Minimally Invasive Versus Open Pancreaticoduodenectomy. / Nassour, Ibrahim; Wang, Sam C.; Christie, Alana; Augustine, Mathew M.; Porembka, Matthew R.; Yopp, Adam C.; Choti, Michael A.; Mansour, John C.; Xie, Xian Jin; Polanco, Patricio M.; Minter, Rebecca M.

In: Annals of Surgery, Vol. 268, No. 1, 01.07.2018, p. 151-157.

Research output: Contribution to journalArticle

Nassour, Ibrahim ; Wang, Sam C. ; Christie, Alana ; Augustine, Mathew M. ; Porembka, Matthew R. ; Yopp, Adam C. ; Choti, Michael A. ; Mansour, John C. ; Xie, Xian Jin ; Polanco, Patricio M. ; Minter, Rebecca M. / Minimally Invasive Versus Open Pancreaticoduodenectomy. In: Annals of Surgery. 2018 ; Vol. 268, No. 1. pp. 151-157.
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abstract = "Objective: To compare the perioperative outcomes of minimally invasive pancreaticoduodenectomy (MIPD) in comparison with open pancreaticoduodenectomy (OPD) in a national cohort of patients. Background: Limited well-controlled studies exist comparing perioperative outcomes between MIPD and OPD. Methods: Patients who underwent MIPD and OPD were abstracted from the 2014 to 2015 pancreas-targeted American College of Surgeons National Surgical Quality Improvement Program. OPD and MIPD patients were matched 3:1 using propensity score, and perioperative outcomes were compared. Results: A total of 4484 patients were identified with 334 (7.4{\%}) undergoing MIPD. MIPD patients were younger, more likely to be White, and had a lower rate of weight loss. They were more likely to undergo classic Whipple and to have a drain placed. After 3:1 matching, 1002 OPD patients were compared with 334 MIPD patients. MIPD was associated with longer mean operative time (426.6 vs 359.6 minutes; P < 0.01), higher readmission rate (19.2{\%} vs 14.3{\%}; P = 0.04) and lower rate of prolonged length of stay >14 days (16.5{\%} vs 21.6{\%}; P = 0.047). The 2 groups had a similar rate of 30-day mortality (MIPD 1.8{\%} vs OPD 1.3{\%}; P = 0.51), overall complications, postoperative pancreatic fistula, and delayed gastric emptying. A secondary analysis comparing MIPD without conversion or open assist with OPD showed that MIPD patients had lower rates of overall surgical site infection (13.4{\%} vs 19.6{\%}; P = 0.04) and transfusion (7.9{\%} vs 14.4{\%}; P = 0.02). Conclusions: MIPD had an equivalent morbidity and mortality rate to OPD, with the benefit of a decreased rate of prolonged length of stay, though this is partially offset by an increased readmission rate.",
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AU - Wang, Sam C.

AU - Christie, Alana

AU - Augustine, Mathew M.

AU - Porembka, Matthew R.

AU - Yopp, Adam C.

AU - Choti, Michael A.

AU - Mansour, John C.

AU - Xie, Xian Jin

AU - Polanco, Patricio M.

AU - Minter, Rebecca M.

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