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Updated: Aug 22, 2025
Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy
Published on: June 17, 2018
Effect of Operative Time on Outcomes of Minimally Invasive Versus Open Pancreatoduodenectomy
Michael D Williams1,2, Anuradha R Bhama3, Samer Naffouje4
1Department of Surgery, Rush University Medical Center, Chicago, IL, USA.
Objective:
To evaluate how operative time interacts with outcomes among different approaches to pancreaticoduodenectomy (PD). Minimally invasive PDs (MIPD), which include laparoscopic (LPD) and robotic (RPD) approaches, are increasingly performed in the USA. MIPD are generally associated with longer operative times (OT) compared to open PD (OPD). Increased OT is associated with inferior outcomes for OPD; however, the effect of OT on MIPD is not well understood.
Methods:
National Surgical Quality Improvement Program (NSQIP)-targeted pancreatectomy dataset was utilized (2014-2019). Propensity score matching, logistic regression, and mixed effect modeling were performed to determine the effect of OT on outcomes following PD. OTs were stratified by quartiles for each approach, and outcomes were subsequently compared.
Results:
Among 23,988 PDs, 22,185 were OPD and 1803 MIPD. Increased OT was associated with greater overall morbidity in all approaches. When comparing OT quartiles, MIPD was consistently associated with improved overall morbidity compared to OPD in matched cohorts. However, for upper quartiles, prolonged OT in MIPD was associated with significantly increased reoperation rates and mortality. The effect of OT on overall morbidity and other outcomes was comparable among LPD and RPD.
Conclusions:
In this study, increased OT was associated with incremental increases in overall morbidity after PD, irrespective of approach. While MIPD was associated with improved overall morbidity compared to OPD when stratified by OT quartile, higher mortality rates were observed with prolonged OT only with MIPD. Those data suggest that MIPD is a safe alternative to OPD when OT is optimized. NSQIP was used to compare the effect of operative time (OT) on outcomes following pancreaticoduodenectomy (PD), stratified by approach. Increased OT was associated with inferior outcomes following open, laparoscopic, and robotic PD. Surgeons should attempt to optimize OT, regardless of the approach to PD.
Insights
Longer operative times (OT) increase complications after pancreaticoduodenectomy (PD). Minimally invasive PD (MIPD) shows better outcomes than open PD (OPD), but prolonged OT in MIPD increases mortality. Optimizing OT is crucial for all PD approaches.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Medical Informatics
Background:
- Minimally invasive pancreaticoduodenectomy (MIPD) is increasingly adopted, often involving longer operative times (OT) than open pancreaticoduodenectomy (OPD).
- The impact of extended OT on outcomes for MIPD is not well-established, unlike for OPD where it correlates with poorer results.
Purpose of the Study:
- To investigate the relationship between operative time (OT) and patient outcomes across different pancreaticoduodenectomy (PD) approaches.
- To determine if extended OT disproportionately affects minimally invasive techniques (MIPD) compared to open procedures (OPD).
Main Methods:
- Analysis of the National Surgical Quality Improvement Program (NSQIP) pancreatectomy dataset (2014-2019).
- Utilized propensity score matching, logistic regression, and mixed-effects modeling to assess OT's effect on PD outcomes.
- Stratified OT into quartiles for open pancreaticoduodenectomy (OPD), laparoscopic (LPD), and robotic (RPD) approaches for comparative analysis.
Main Results:
- Increased OT correlated with higher overall morbidity across all PD approaches.
- Minimally invasive PD (MIPD) demonstrated superior overall morbidity compared to OPD across OT quartiles.
- However, prolonged OT within MIPD (upper quartiles) was linked to significantly increased reoperation rates and mortality.
- Outcomes between laparoscopic (LPD) and robotic (RPD) approaches showed comparable effects of OT on morbidity.
Conclusions:
- Extended operative time (OT) is associated with increased overall morbidity following pancreaticoduodenectomy (PD), regardless of surgical approach.
- While minimally invasive pancreaticoduodenectomy (MIPD) offers better overall morbidity than open pancreaticoduodenectomy (OPD), prolonged OT in MIPD specifically elevates mortality risks.
- Optimizing operative time is essential for ensuring the safety and efficacy of all pancreaticoduodenectomy (PD) procedures, including MIPD.
