Surgical and Oncologic Outcomes of Open Versus Laparoscopic Distal Pancreatectomy in a Low-volume Setting
*Susanna W de Geus, *Kurt S. Schultz, *Timothy Feeney, *Sing Chau Ng, *Thurston F. Drake, David McAneny, Jennifer F. Tseng, Teviah E. Sachs
Boston Medical Center, Boston, MA
Objective: Published studies promoting minimally invasive pancreatectomy have been criticized for high-volume and/or single center bias. We sought to compare surgical and oncologic outcomes of patients with pancreatic cancer who underwent laparoscopic distal pancreatectomy (LDP) versus open distal pancreatectomy (ODP) in lower-volume hospitals.
Design: Retrospective cohort study
Setting: Low-volume hospitals (≤ 5 distal pancreatectomies per year).
Patients: Patients ≥ 18 years old with any pancreatic cancer who underwent distal pancreatectomy at a low-volume center between 2010 and 2014 were identified from the National Cancer Database (NCDB). Propensity scores were created for the odds of undergoing LDP. Patients were matched 1:1 based on propensity score.
Interventions: LDP vs. ODP.
Main outcome measures: 30-day mortality, 90-day mortality, median hospital length of stay (LOS), unplanned 30-day readmission, surgical margins, number of lymph nodes harvested, and survival.
Results: Of the 2,842 eligible patients, 902 (31.7%) underwent LDP and 1,940 (68.3%) underwent ODP. Overall, 203 (22.5%) laparoscopic cases were converted to open. After matching, LDP was predictive of decreased 90-day mortality (3.6% vs. 5.9%; p=0.0196), shorter LOS (6 vs. 7 days; p<0.0001), and fewer positive resection margins (12.5% vs. 18.5%; p=0.0004). There were no differences with respect to 30-day mortality (1.7% vs. 2.9%; p=0.0823), readmission (9.6% vs. 7.4%; p=0.0920), and number of lymph nodes harvested (7 vs. 8 nodes; p=0.2113). For pancreatic adenocarcinoma patients demonstrated similar median overall survival for patients who underwent LDP versus ODP (23.4 vs. 22.3 months; log-rank p=0.2460) after propensity-score matching.
Conclusions: The results of this study suggest that, even in low-volume settings, LDP is associated with reduced 90-day mortality, shorter length of hospital stay, and lower rates of positive resection margins in well-selected patients.
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