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Minimally invasive versus open distal pancreatectomy: a matched analysis using ACS-NSQIP
Alexandra M Adams1, Dylan M Russell2, Elizabeth L Carpenter3
1Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX, 78234, USA.
Surgical Endoscopy
|June 15, 2022
Summary
Minimally invasive distal pancreatectomy (MIDP) offers shorter hospital stays but shows higher rates of post-operative pancreatic fistula (POPF) compared to open distal pancreatectomy (ODP). Further research is needed to address this POPF risk in MIDP.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Comparative Effectiveness Research
Background:
- Minimally invasive distal pancreatectomy (MIDP) is increasingly adopted for its potential to improve patient recovery compared to open distal pancreatectomy (ODP).
- This study addresses the need for robust comparative data on MIDP versus ODP outcomes within a large national patient cohort.
Purpose of the Study:
- To compare the perioperative outcomes, specifically post-operative pancreatic fistula (POPF) and major morbidity, between MIDP and ODP.
- To evaluate the safety and efficacy of MIDP relative to ODP using nationwide data.
Main Methods:
- Utilized the American College of Surgeons' National Quality Improvement Program (2014-2018) database.
- Matched patients undergoing MIDP and ODP using a Mahalanobis-distance model based on demographics, preoperative risk factors, and pathology.
- Assessed POPF incidence and 30-day composite major morbidity via weighted multiple logistic regression.
Main Results:
- After matching, 2985 patients (1978 MIDP, 1007 ODP) were analyzed.
- Major morbidity rates were similar between MIDP (8.65%) and ODP (9.76%).
- MIDP demonstrated a significantly shorter length of stay (5.6 vs. 7 days) but a higher incidence of POPF (12.54% vs. 9.35%).
Conclusions:
- MIDP is associated with reduced hospitalization duration but an increased risk of POPF compared to ODP when controlling for baseline characteristics.
- Further investigation is warranted to understand the mechanisms behind the elevated POPF rates in MIDP and to refine surgical techniques to mitigate this risk.
