Morbidity and Survival After Laparoscopic Versus Open Pancreatoduodenectomy: Propensity Score Matched Comparison

Overview

Journal Langenbecks Arch Surg

Specialty General Surgery

Date 2023 Jan 9

PMID 36624235

Authors

Mathieu Vandeputte

Franky Vansteenkiste

Wim Ceelen

Celine De Meyere

Mathieu DHondt

Affiliations

Soon will be listed here.

Abstract

Purpose: Technical challenges and a perceived higher risk of complications hinder a wide adoption of minimally invasive pancreatoduodenectomy. We aim to further define the place of minimally invasive pancreatoduodenectomy by comparison with the traditional open approach.

Methods: A comparison of the surgical outcomes and survival after laparoscopic (LPD) versus open pancreatoduodenectomy (OPD) was retrospectively performed from a prospectively kept database. To reduce the effect of bias and confounding, baseline characteristics of both groups were matched using propensity score matching (NCT05110573; Nov 8, 2021; retrospectively registered).

Results: From a total of 67 LPD and 105 OPD patients, propensity score matching resulted in two balanced groups of 38 patients. In both groups, 87% of surgeries were performed for cancer. In the LPD group, conversion rate was 22.4%. Mean operative time was significantly longer after LPD versus OPD (320.1 ± 53.8 vs. 277.7 ± 63.8 min; p = .008). Hospital stay was significantly shorter after LPD versus OPD (median 13.5 vs. 17.0 days; p = .039). No significant differences were observed in blood loss, total complication rate (73.7% vs. 86.8%; p = .249), major complication rate (26.5% vs. 10.5%; p = .137), postoperative pancreatic fistula rate (13.2% vs. 7.9%; p = .711), 90-day mortality rate (5.3% vs. 0%; p = .493), R0 resection rate (85.4% vs. 85.8%), or number of lymph nodes (median 10.0 vs. 8.5; p = .273). In cancer patients, no significant differences were observed in overall survival (median 27.1 vs. 23.9 months; p = .693), disease-free survival, or recurrence rate.

Conclusion: LPD provided acceptable short-term and oncological outcomes. Compared to OPD, we noted a higher major complication rate, without compromising surgical safety or oncological outcomes.

Citing Articles

Effects of Minimally Invasive Versus Open Pancreatoduodenectomy on Short-Term Surgical Outcomes and Postoperative Nutritional and Immunological Statuses: A Single-Institution Propensity Score-Matched Study.

Yumoto S, Hayashi H, Mima K, Ogawa D, Itoyama R, Kitano Y Ann Surg Open. 2024; 5(3):e487.

PMID: 39310352 PMC: 11415100. DOI: 10.1097/AS9.0000000000000487.

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