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Updated: Oct 3, 2025
Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy
Published on: June 17, 2018
Minimally invasive vs open pancreatoduodenectomy on oncological adequacy: a propensity score-matched analysis
Yazan Ashouri1, Katherine Ho2, Helen Ho1
1Southern Arizona VA Health Care System, Department of Surgery, University of Arizona, Tucson, AZ, USA.
Background:
The adoption of minimally invasive pancreatoduodenectomy (MIPD) has increased over the last decade. Most of the data on perioperative and oncological outcomes derives from single-center high-volume hospitals. The impact of MIPD on oncological outcomes in a multicenter setting is poorly understood.
Methods:
The National Cancer Database was utilized to perform a propensity score matching analysis between MIPD vs open pancreatoduodenectomy (OPD). The primary outcomes were lymphadenectomy ≥ 15 nodes and surgical margins. Secondary outcomes were 90-day mortality, length of stay, and overall survival.
Results:
A total of 10,246 patients underwent pancreatoduodenectomy for ductal adenocarcinoma between 2010 and 2016. Among these patients, 1739 underwent MIPD. A propensity score matching analysis with a 1:2 ratio showed that the rate of lymphadenectomy ≥ 15 nodes was significantly higher for MIPD compared to OPD, 68.4% vs 62.5% (P < .0001), respectively. There was no statistically significant difference in the rate of positive margins, 90-day mortality, and overall survival. OPD was associated with an increased rate of length of stay > 10 days, 36.6% vs 33% for MIPD (P < .01). Trend analysis for the patients who underwent MIPD revealed that the rate of adequate lymphadenectomy increased during the study period, 73.1% between 2015 and 2016 vs 63.2% between 2010 and 2012 (P < .001). In addition, the rate of conversion to OPD decreased over time, 29.3% between 2010 and 2012 vs 20.2% between 2015 and 2016 (P < .001).
Conclusion:
In this propensity score matching analysis, the MIPD approach was associated with a higher rate of adequate lymphadenectomy and a shorter length of stay compared to OPD. The surgical margins status, 90-day mortality, and overall survival were similar between the groups.
Insights
Minimally invasive pancreatoduodenectomy (MIPD) offers improved lymphadenectomy rates and shorter hospital stays compared to open procedures. Oncological outcomes and survival remain comparable between MIPD and open pancreatoduodenectomy (OPD).
Area of Science:
- Surgical Oncology
- Gastrointestinal Surgery
- Minimally Invasive Surgery
Background:
- Minimally invasive pancreatoduodenectomy (MIPD) adoption is rising, yet multicenter data on its oncological outcomes is limited.
- Existing evidence often comes from single-center, high-volume institutions, necessitating broader investigation.
- The comparative impact of MIPD versus open pancreatoduodenectomy (OPD) in a real-world, multicenter setting requires further clarification.
Purpose of the Study:
- To evaluate the oncological and perioperative outcomes of MIPD compared to OPD.
- To assess the impact of surgical approach on lymphadenectomy adequacy, surgical margins, and survival.
- To analyze trends in MIPD adoption and outcomes over time in a multicenter setting.
Main Methods:
- A propensity score matching analysis was conducted using the National Cancer Database (2010-2016).
- Patients undergoing pancreatoduodenectomy for ductal adenocarcinoma were included (n=10,246).
- Primary outcomes: lymphadenectomy (≥15 nodes) and surgical margins; Secondary outcomes: 90-day mortality, length of stay, and overall survival.
Main Results:
- MIPD was associated with a significantly higher rate of adequate lymphadenectomy (≥15 nodes) compared to OPD (68.4% vs 62.5%, P<.0001).
- No significant differences were observed in positive surgical margins, 90-day mortality, or overall survival between MIPD and OPD.
- OPD was linked to a longer length of stay (>10 days) compared to MIPD (36.6% vs 33%, P<.01).
- Trends showed increased adequate lymphadenectomy and decreased conversion rates to OPD over the study period for MIPD.
Conclusions:
- MIPD is associated with superior lymphadenectomy adequacy and shorter hospital stays compared to OPD.
- Oncological outcomes, including surgical margins and overall survival, are similar between MIPD and OPD.
- The findings support MIPD as a viable alternative to OPD, with improving outcomes over time.
