Minimal-invasive approach to pancreatoduodenectomy is associated with lower early postoperative morbidity

We aim to investigate the impact of the operation time for pancreatoduodenectomy (PD) in different surgical approaches.

The NSQIP database was used to examine the clinical data of patients underwent PD during 2014-2016.

We sampled a total of 6151 patients who underwent elective PD. Of these, 452(7.3%) had minimally invasive approaches to PD. Minimally invasive approaches (MIS) to PD was associated with a significant decrease in morbidity of patients (AOR: 0.67, P < 0.01). Following risk adjustment for morbidity predictors, operation length was statistically associated with post-operative morbidity (AOR: 1.002, P < 0.01). Although MIS procedures were significantly longer operations compared to open procedures (443 min vs. 371 min, CI: 53-82 min, P < 0.01), MIS approaches were associated with significantly decreased morbidity in low stage tumors (stage zero-II) (51.3% vs. 56.2%, AOR: 0.72, P = 0.03) and advanced stage disease (stage III-IV) (50% vs. 60.3%, AOR: 0.38, P = 0.04).

Minimally invasive approaches to PD were associated with decreased post-operative morbidity, even though they were associated with longer operative times. Operation length also significantly correlated with postoperative morbidity.