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Safety of Minimally Invasive Distal Pancreatectomy Outside a High Volume Center
*Christian Arroyo1, *David Eisenberg2, *Michael Carlton2, *Michael O'Loughlin2, *Christina Wai2, Ramon Jimenez2
1University of Connecticut Medical School, Farmington, CT;2Hartford Hospital, Hartford, CT
Objective: Centralization of pancreatic resections to high volume (HV) centers has been advocated to improve perioperative outcomes. Multiple publications document that minimally invasive pancreatic resections are underutilized nationally, even at HV centers. We investigated whether we could develop a program of minimally invasive distal pancreatectomy (MIDP) at our institution, which is not a HV center.
Design: Case series 2009-2015.
Setting: Intermediate volume center (<50 major pancreatic resections/year)
Patients: Consecutive sample. Pancreas neoplasia only.
Interventions: Open vs. MIDP.
Main Outcome Measures: Successful MIDP.
Results: The study group included 46 patients, 27 MIDP and 19 open procedures. The cohort included 30% neuroendocrine tumors, 35% cystic neoplasms, and 24% adenocarcinomas. There was no difference in age (63 vs 67), gender (59% vs 58% males), BMI (29.7 kg/m2 vs 27.2kg/m2), or diagnosis between the MIDP and open groups. The primary selection criteria for MIDP was longer tumor distance from the spleno-portal vein confluence (5.1cm vs 1.3cm, p<0.001). Patients in the open group required pancreatic transection at the neck of the gland more often (74% vs 0%, P<0.001), and had a higher rate of positive margin (32% vs. 0%, p<0.003). There was no difference in lymph node harvest between groups. Conversion rate for MIDP was 15%. Postoperative complications (1 mortality, 6 fistulas, and 8 readmissions) showed no differences between the groups. MIDP had shorter length-of-stays (5.6 vs. 7.1 days, p<0.05).
Conclusions: We demonstrate that MIDP can be applied safely outside HV centers. MIDP was not associated with increased perioperative morbidity, maintained sound oncologic principles, and offered shorter hospital stays. Our data compares favorably with publications from HV centers. Centralization of pancreatic surgery should not be based solely on case volume.
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