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Updated: Jun 6, 2025
Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy
Published on: June 17, 2018
A Comparative Analysis of Open Versus Minimally Invasive Pancreatoduodenectomies
Catherine S Valukas1, Norah M Zaza1, Dominic Vitello1
1Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern Medicine, Chicago, Illinois, USA.
Background And Objectives:
Pancreatoduodenectomy (PD) has been associated with significant morbidity and mortality. To reduce morbidity, minimally invasive pancreatoduodenectomies (MIPD) have become more prevalent. We aimed to compare short-term survival and complications for open (OPD) versus MIPD and to assess the relationship between operative approach and operative time on outcomes.
Methods:
Patients undergoing PD between 2017 and 2020 were identified within the National Surgical Quality Improvement Program (NSQIP). The primary outcome was operative time, and the secondary outcomes were death at 30 days, reoperation, readmission, and NSQIP-identified 30-day postoperative complications. A multivariable logistic regression was performed.
Results:
A total of 14 977 PDs were performed from 2017 to 2020. MIPD increased from less than 8% of pancreatoduodenectomies performed in 2017 to over 10% of PD by 2020. Of the MIPD cohort, 62% were robotic, and 38% were laparoscopic, with robotic surgery becoming most prevalent by the end of the study period. MIPD was associated with significantly longer operative times than OPD (p < 0.01). MIPD was associated with decreased odds of postoperative bleeding and surgical site infection (p < 0.01), but higher odds of death at 30 days.
Conclusions:
MIPD has been shown to have improved postoperative outcomes compared to OPD but is associated with longer operative times, which can be associated with increased complications.
Insights
Minimally invasive pancreatoduodenectomy (MIPD) shows fewer complications like bleeding and infection than open pancreatoduodenectomy (OPD). However, MIPD involves longer operative times and a higher 30-day mortality risk.
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.
