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Survival After Minimally Invasive vs Open Surgery for Pancreatic Adenocarcinoma
Halit Topal1, Raymond Aerts1, Annouschka Laenen2
1Department of Visceral Surgery, University Hospitals KU Leuven, Leuven, Belgium.
Importance:
Only a few high-volume centers have reported on long-term oncologic outcomes after minimally invasive pancreatic surgery (MIPS) for pancreatic adenocarcinoma, but none of them have shown superior long-term overall survival (OS) compared with open pancreatic surgery (OPS).
Objective:
To study long-term survival after MIPS and OPS with curative intent among patients with pancreatic adenocarcinoma.
Design, Setting, And Participants:
This comparative effectiveness study used a retrospective analysis of a prospectively maintained electronic database of patient data collected between January 2010 and December 2019. Consecutive patients from a high-volume pancreatic cancer referral center were included. Data analysis was conducted from March to October 2022. Median follow-up time was 56.8 months.
Exposures:
Patients were matched using propensity score models to study long-term survival.
Main Outcomes And Measures:
Survival outcomes were analyzed using the Cox proportional hazards model. Variables used for propensity score correction were TNM stage, tumor dimension, lymph node status, type of operation, simultaneous vascular resection, neoadjuvant chemotherapy, adjuvant chemotherapy, sex, age, and American Society of Anesthesiologists score. Additional corrections were made for year of surgery and type of adjuvant chemotherapy.
Results:
After propensity score matching the sample of 396 patients, there were 198 patients in the MIPS group (89 [44.9%] men; median [range] age, 68 [32-87] years) and 198 in the OPS group (94 [47.5%] men; median [range] age, 67 [39-84] years). Median OS in the MIPS group was 30.7 (95% CI, 26.2-36.8) months compared with 20.3 (95% CI, 17.6-23.5) months after OPS (hazard ratio [HR], 0.70; 95% CI, 0.56-0.87; P = .002). Median disease-free survival (DFS) after MIPS vs OPS was 14.8 (95% CI, 11.8-17.0) months vs 10.7 (95% CI, 9.0-12.1) months (HR, 0.71; 95% CI, 0.57-0.89; P = .003). Additional corrections for year of surgery and type of adjuvant chemotherapy showed better OS (year of surgery: HR, 0.74; 95% CI, 0.57-0.96; P = .02; adjuvant chemotherapy: HR, 0.71; 95% CI, 0.56-0.90; P = .005) and DFS (year of surgery: HR, 0.77; 95% CI, 0.59-0.99; P = .04; adjuvant chemotherapy: HR, 0.72; 95% CI, 0.57-0.92; P = .009) for patients undergoing minimally invasive vs open surgery.
Conclusions And Relevance:
In this study of 396 patients with borderline resectable and resectable pancreatic adenocarcinoma, MIPS was associated with better OS and DFS than OPS. Centralization of MIPS should be stimulated, and pancreatic surgeons should be encouraged to pass the learning curve before implementing MIPS for pancreatic adenocarcinoma in daily clinical practice.
Insights
Minimally invasive pancreatic surgery (MIPS) shows improved long-term survival and disease-free survival compared to open pancreatic surgery (OPS) for pancreatic adenocarcinoma. Surgeons should adopt MIPS to enhance patient outcomes.
Area of Science:
- Surgical Oncology
- Gastroenterology
Background:
- Minimally invasive pancreatic surgery (MIPS) for pancreatic adenocarcinoma has limited reported long-term oncologic outcomes.
- No previous studies demonstrated superior long-term overall survival (OS) for MIPS compared to open pancreatic surgery (OPS).
Purpose of the Study:
- To compare long-term survival outcomes between MIPS and OPS in patients with pancreatic adenocarcinoma undergoing curative-intent surgery.
Main Methods:
- Retrospective analysis of a prospectively maintained electronic database (2010-2019) from a high-volume pancreatic cancer center.
- Propensity score matching was used to compare 198 patients in the MIPS group with 198 patients in the OPS group.
- Survival outcomes were analyzed using the Cox proportional hazards model, with adjustments for multiple clinical variables.
Main Results:
- MIPS was associated with significantly better median OS (30.7 months) compared to OPS (20.3 months) (HR, 0.70; P=.002).
- Median disease-free survival (DFS) was also superior for MIPS (14.8 months) versus OPS (10.7 months) (HR, 0.71; P=.003).
- Adjusted analyses confirmed improved OS and DFS for MIPS, irrespective of surgery year or adjuvant chemotherapy type.
Conclusions:
- Minimally invasive pancreatic surgery (MIPS) demonstrates superior long-term overall survival and disease-free survival compared to open pancreatic surgery (OPS) for pancreatic adenocarcinoma.
- Centralization of MIPS and surgeon training are recommended to improve patient outcomes.
- Further research and adoption of MIPS in clinical practice are encouraged.
