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Updated: Oct 21, 2025
Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy
Published on: June 17, 2018
Implementation of Minimally Invasive Pancreaticoduodenectomy at Low and High-Volume Centers
Robert J Torphy1, Chloe Friedman1, Alison L Halpern1
1Department of Surgery, University of Colorado, Aurora, Colorado.
Background:
There is a need to better define the safety of implementing the use of minimally invasive pancreaticoduodenectomy (MIPD) in order to provide evidence for safe application. The objective of this study was to evaluate the mortality associated with the implementation of MIPD across low and high-volume facilities using the National Cancer Database (NCDB).
Methods:
Patients in the NCDB with pancreatic cancer diagnosed from 2010-2016 undergoing MIPD were selected. Cumulative MIPD volume for each facility was calculated from the number of MIPD cases performed each year prior to and including the year of a patient's operation. A random effects logistic regression model was used to examine the adjusted association between log-transformed cumulative MIPD volume and 90-day mortality.
Results:
After controlling for patient, tumor and facility-related variables, there was decreased 90-day mortality as the cumulative MIPD volume increased (OR 0.81; 95% CI 0.69-0.95; P = 0.009). Average annual open pancreaticoduodenectomy (PD) volume was independently protective throughout the implementation phase (OR 0.98; 95% CI 0.97-0.99; P = 0.049). This equates to an average predicted probability of 90-day mortality for the first 5 cumulative MIPD cases of 7.51% at a low-volume facility (5 open PDs per year) versus 4.39% at a high-volume facility (50 open PDs per year).
Conclusions:
Using the NCDB, 90-day mortality following MIPD decreased with higher cumulative facility MIPD case volume. Although higher cumulative MIPD case volume was associated with reduced 90-day mortality at both low and high-volume facilities, the higher mortality during the implementation of MIPD is magnified at low-volume facilities. This retrospective analysis demonstrates that MIPD can be safely implemented with low mortality at facilities with high-volume open PD programs.
Insights
Minimally invasive pancreaticoduodenectomy (MIPD) shows decreased 90-day mortality with increased cumulative case volume. High-volume open pancreaticoduodenectomy (PD) programs enhance MIPD safety, especially at lower-volume facilities.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Health Services Research
Background:
- Minimally invasive pancreaticoduodenectomy (MIPD) implementation requires safety definition.
- Evaluating MIPD safety across varying facility volumes is crucial for evidence-based application.
Purpose of the Study:
- To assess 90-day mortality rates associated with MIPD implementation.
- To compare MIPD outcomes in low-volume versus high-volume surgical centers using the National Cancer Database (NCDB).
Main Methods:
- Retrospective analysis of pancreatic cancer patients undergoing MIPD (2010-2016) from the NCDB.
- Calculation of cumulative MIPD volume per facility and logistic regression to assess its association with 90-day mortality.
- Inclusion of patient, tumor, and facility variables for adjusted analysis.
Main Results:
- Increased cumulative MIPD volume was significantly associated with decreased 90-day mortality (OR 0.81, P=0.009).
- Higher annual open pancreaticoduodenectomy (PD) volume was independently protective (OR 0.98, P=0.049).
- Predicted 90-day mortality for initial MIPD cases was higher in low-volume (7.51%) vs. high-volume (4.39%) facilities.
Conclusions:
- Higher cumulative MIPD volume correlates with reduced 90-day mortality.
- MIPD can be safely implemented, particularly in facilities with established high-volume open PD programs.
- Low-volume facilities experience magnified mortality risks during MIPD implementation.
