A Comparative Analysis of Open Versus Minimally Invasive Pancreatoduodenectomies

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Pancreatoduodenectomy (PD) is a major surgery with significant risks.
• Minimally invasive approaches (MIPD) are increasingly adopted to mitigate these risks.
• This study compares outcomes of open (OPD) versus minimally invasive (MIPD) pancreatoduodenectomy.

Purpose of the Study:

• To compare short-term survival and complication rates between OPD and MIPD.
• To evaluate the impact of operative approach and operative time on patient outcomes.
• To analyze trends in the adoption of MIPD.

Main Methods:

• Analysis of 14,977 PD cases from the National Surgical Quality Improvement Program (NSQIP) database (2017-2020).
• Comparison of operative time, 30-day mortality, reoperation, readmission, and postoperative complications between OPD and MIPD.
• Multivariable logistic regression was employed to assess outcomes.

Main Results:

• MIPD utilization increased from <8% in 2017 to >10% by 2020, with robotic surgery dominating.
• MIPD was associated with significantly longer operative times compared to OPD (p<0.01).
• MIPD demonstrated reduced odds of postoperative bleeding and surgical site infection but showed higher odds of 30-day mortality.

Conclusions:

• MIPD offers improved postoperative outcomes regarding specific complications compared to OPD.
• Longer operative times in MIPD may be linked to increased overall complications, including mortality.
• Further research is needed to optimize MIPD techniques and mitigate associated risks.