Minimally invasive distal pancreatectomy for adenocarcinoma of the pancreas

Laura Nicolais, Division of Surgical Oncology, Tufts University School of Medicine-Maine Medical Center, Portland, ME, USA.
Abdimajid Mohamed, Division of Surgical Oncology, Tufts University School of Medicine-Maine Medical Center, Portland, ME, USA.
Timothy L. Fitzgerald, Division of Surgical Oncology, Tufts University School of Medicine-Maine Medical Center, Portland, ME, USA. Electronic address: timothy.fitzgerald@mainehealth.org.

Abstract

INTRODUCTION: Minimally invasive (MI) surgery has been widely adopted to treat left-sided pancreatic cancer. However, outcomes are not clearly defined. MATERIALS: Retrospective cohort study utilizing NCDB and NSQIP data. RESULTS: Patients undergoing distal pancreatectomy for pancreatic adenocarcinoma from 2004 to 2016 were included (n = 7347). Utilizing NSQIP (n = 2406), patients were divided into two groups: intention-to-treat (ITT) MI (including MI converted to open, n = 929) and open (n = 1477). Patients undergoing open pancreatectomy were more likely to have longer length of stay (6 vs. 5 days, p=<0.001). On multivariate analysis, open procedures were not associated with mortality (OR 1.24; CI 0.51-3.30, p = 0.64), serious complications (OR 1.03; CI 0.90-1.37, p = 0.79), and any complications (OR 1.07; CI 0.86-1.32, p = 0.56). NCDB patients (n = 4941) were also divided into two groups, ITT MI (n = 1,769, 36%) and open group (n = 3,172, 64%). The median survival was lower in open procedure patients, 23 vs. 27.1 months (p < 0.001). This finding was maintained on multivariable analysis (HR 1.16; CI 1.03-1.32, p = 0.017). CONCLUSION: Based on these data, MI distal pancreatectomy could be considered a standard of care for pancreatic cancer when technically feasible. Although morbidity and mortality were similar, the laparoscopic approach had a shorter length of stay and could hasten recovery.