Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Impact of conversion at time of minimally invasive pancreaticoduodenectomy on perioperative and long-term outcomes: Review of the National Cancer Database

  • Jennifer Palacio (Department of General Surgery, Memorial Healthcare System) ;
  • Daisy Sanchez (Department of General Surgery, Memorial Healthcare System) ;
  • Shenae Samuels (Office of Human Research, Memorial Healthcare System) ;
  • Bar Y. Ainuz (Herbert Wertheim College of Medicine, Florida International University) ;
  • Raelynn M. Vigue (Herbert Wertheim College of Medicine, Florida International University) ;
  • Waleem E. Hernandez (Herbert Wertheim College of Medicine, Florida International University) ;
  • Christopher J. Gannon (Division of Surgical Oncology, Memorial Healthcare System) ;
  • Omar H. Llaguna (Division of Surgical Oncology, Memorial Healthcare System)
  • Received : 2022.10.17
  • Accepted : 2023.01.25
  • Published : 2023.08.31
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Abstract

Backgrounds/Aims: Current literature presents limited data regarding outcomes following conversion at the time of minimally invasive pancreaticoduodenectomy (MI-PD). Methods: The National Cancer Database was queried for patients who underwent pancreaticoduodenectomy. Patients were stratified into three groups: MI-PD, converted to open pancreaticoduodenectomy (CO-PD), and open pancreaticoduodenectomy (O-PD). Multivariable modeling was applied to compare outcomes of MI-PD and CO-PD to those of O-PD. Results: Of 17,570 patients identified, 12.5%, 4.2%, and 83.4% underwent MI-PD, CO-PD, and O-PD, respectively. Robotic pancreaticoduodenectomy (R-PD) resulted in a higher lymph node yield (n = 23.2 ± 12.2) even when requiring conversion (n = 22.4 ± 13.2, p < 0.001). Margin positivity was higher in the CO-PD group (26.6%) than in the MI-PD group (21.3%) and the O-PD (22.6%) group (p = 0.017). Length of stay was shorter in the MI-PD group (laparoscopic pancreaticoduodenectomy 10.4 ± 8.6, R-PD 10.6 ± 8.8) and the robotic converted to open group (10.7 ± 6.4) than in the laparoscopic converted to open group (11.2 ± 9) and the O-PD group (11.5 ± 8.9) (p < 0.001). After adjusting for patient and tumor characteristics, both MI-PD (odds ratio = 1.40; p < 0.001) and CO-PD (odds ratio = 1.24; p = 0.020) were significantly associated with an increased likelihood of long-term survival. Conclusions: CO-PD does not negatively impact perioperative or oncologic outcomes.

Keywords

Acknowledgement

Abstract presented at Americas Hepato-Pancreato-Biliary Association Annual Meeting, Miami Beach, FL, 2021. International Hepato-Pancreato-Biliary Association World Conference, New York City, NY, 2022.

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