Comparing Short-term and Oncologic Outcomes of Minimally Invasive Versus Open Pancreaticoduodenectomy Across Low and High Volume Centers

Torphy, Robert J.; Friedman, Chloe; Halpern, Alison L.; Chapman, Brandon C.; Ahrendt, Steven S.; McCarter, Martin; Edil, Barish H.; Schulick, Richard D.; Gleisner, Ana

doi:10.1097/sla.0000000000002810

Cited by 127 publications

(97 citation statements)

References 22 publications

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“…Despite initial hesitance, MIPD has been increasingly adopted over the past decade. A recent review of the National Cancer Database in the United States reported that between 2010 and 2015, 3754 (17.1%) of 22 013 PDs for pancreatic cancer were performed via MIS . Furthermore, there was no difference in perioperative and oncological outcomes between MIPD and open PD (OPD) in this database registry study.…”

Section: Discussionmentioning

confidence: 63%

Initial experience with laparoscopic and robotic surgery for the treatment of periampullary tumours: single institution experience with the first 30 consecutive cases

Goh

Low

Kam

et al. 2019

ANZ Journal of Surgery

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Background: Concerns have been raised about the safety of minimally invasive surgery (MIS) for pancreatoduodenectomy (PD) during the early learning phase. In this study, we present our initial experience with MIS for periampullary tumours. Methods: Retrospective review of the first 30 consecutive patients who underwent laparoscopic (LS)/robotic surgery (RS) for periampullary tumours between 2014 and 2017. Results: Twenty-seven patients underwent PD, including three total pancreatectomies (TPs) and three underwent palliative bypasses. Twenty underwent LS, of which 18 were hybrid PDs, including two TPs and two bypasses. Ten patients underwent RS, of which nine were PDs, including one TP and one bypass. Five of 10 RSs were totally MIS procedures. There were four PDs with venous resection, of which three were by RS. There were four (13.3%) open conversions all in the LS cohort. There were five (16.7%) major (>grade 2) morbidities, including three pancreatic fistulas (two grade B and one grade C). There was no 30-day and one (3.3%) 90-day mortality. Comparison between RS and LS demonstrated that RS had a higher likelihood of being completed via totally MIS (five (50%) versus 0, P = 0.002), tended to have a shorter post-operative stay (eight (range 6-36) versus 14.5 (range 6-62) days, P = 0.058) but tended to be associated with a longer operation time (670 (range 500-930) versus 577 (range 235-715) min, P = 0.056). Conclusion: Our initial experience demonstrated that both LS and RS can be safely adopted for the treatment of periampullary tumours. The learning curve for RS seemed to be shorter than LS as we could transition more quickly from hybrid PDs to totally MIS safely. © 2019 Royal Australasian College of Surgeons ANZ J Surg 89 (2019) E137-E141 ANZJSurg.com E138 Goh et al.

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Section: Discussionmentioning

confidence: 63%

Initial experience with laparoscopic and robotic surgery for the treatment of periampullary tumours: single institution experience with the first 30 consecutive cases

Goh

Low

Kam

et al. 2019

ANZ Journal of Surgery

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“…There are two ongoing RCTs comparing EA with intravenous morphine 43 and with intravenous hydromorphone 44 , designed to determine how analgesic technique influences the incidence of complications and mortality after pancreatoduodenectomy. It will be interesting to see how the increasing use of minimally invasive surgery will influence indications for analgesic techniques 45 . Recent experience 46 -48 with sublingual sufentanil (non-invasive, rapid absorption, rapid pain relief, few side-effects) seems promising, leading to a proposed RCT comparing EA with sublingual sufentanil in patients undergoing pancreatoduodenectomy (www .trialregister.nl; TC 7318).…”

Section: Discussionmentioning

confidence: 99%

Meta‐analysis of epidural analgesia in patients undergoing pancreatoduodenectomy

et al. 2019

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BackgroundThe optimal analgesic technique after pancreatoduodenectomy remains under debate. This study aimed to see whether epidural analgesia (EA) has superior clinical outcomes compared with non‐epidural alternatives (N‐EA) in patients undergoing pancreatoduodenectomy.MethodsA systematic review with meta‐analysis was performed according to PRISMA guidelines. On 28 August 2018, relevant literature databases were searched. Primary outcomes were pain scores. Secondary outcomes were treatment failure of initial analgesia, complications, duration of hospital stay and mortality.ResultsThree RCTs and eight cohort studies (25 089 patients) were included. N‐EA treatments studied were: intravenous morphine, continuous wound infiltration, bilateral paravertebral thoracic catheters and intrathecal morphine. Patients receiving EA had a marginally lower pain score on days 0–3 after surgery than those receiving intravenous morphine (mean difference (MD) −0·50, 95 per cent c.i. −0·80 to −0·21; P < 0·001) and similar pain scores to patients who had continuous wound infiltration. Treatment failure occurred in 28·5 per cent of patients receiving EA, mainly for haemodynamic instability or inadequate pain control. EA was associated with fewer complications (odds ratio (OR) 0·69, 95 per cent c.i. 0·06 to 0·79; P < 0·001), shorter duration of hospital stay (MD −2·69 (95 per cent c.i. −2·76 to −2·62) days; P < 0·001) and lower mortality (OR 0·69, 0·51 to 0 93; P = 0·02) compared with intravenous morphine.ConclusionEA provides marginally lower pain scores in the first postoperative days than intravenous morphine, and appears to be associated with fewer complications, shorter duration of hospital stay and less mortality.

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“…The development of MIPD was based on Gagner and Pomp's original LPD description from 1994 [22]. Several studies from high-volume centers have reported that MIPD might be feasible and confer advantages over OPD for benign lesions and periampullary malignancy [23][24][25]. However, reservations concerning the safety of MIPD persist as the majority of hospitals performing MIPD were low-volume centers, and its use has been associated with increased morbidity and mortality [26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Minimally Invasive versus Open Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma: A Propensity Score Matching Analysis

Kwon

Song

Park

et al. 2020

Cancers

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Background: Few studies have compared perioperative and oncological outcomes between minimally invasive pancreatoduodenectomy (MIPD) and open pancreatoduodenectomy (OPD) for pancreatic ductal adenocarcinoma (PDAC). Methods: A retrospective review of patients undergoing MIPD and OPD for PDAC from January 2011 to December 2017 was performed. Perioperative, oncological, and survival outcomes were analyzed before and after propensity score matching (PSM). Results: Data from 1048 patients were evaluated (76 MIPD, 972 OPD). After PSM, 73 patients undergoing MIPD were matched with 219 patients undergoing OPD. Operation times were longer for MIPD than OPD (392 vs. 327 min, p < 0.001). Postoperative hospital stays were shorter for MIPD patients than OPD patients (12.4 vs. 14.2 days, p = 0.040). The rate of overall complications and postoperative pancreatic fistula did not differ between the two groups. Adjuvant treatment rates were higher following MIPD (80.8% vs. 59.8%, p = 0.002). With the exception of perineural invasion, no differences were seen between the two groups in pathological outcomes. The median overall survival and disease-free survival rates did not differ between the groups. Conclusions: MIPD showed shorter postoperative hospital stays and comparable perioperative and oncological outcomes to OPD for selected PDAC patients. Future randomized studies will be required to validate these findings.

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Comparing Short-term and Oncologic Outcomes of Minimally Invasive Versus Open Pancreaticoduodenectomy Across Low and High Volume Centers

Abstract: Patients selected to receive MIPD for cancer have equivalent short-term and oncologic outcomes, when compared with patients who undergo OPD.

Cited by 127 publications

References 22 publications

Initial experience with laparoscopic and robotic surgery for the treatment of periampullary tumours: single institution experience with the first 30 consecutive cases

Initial experience with laparoscopic and robotic surgery for the treatment of periampullary tumours: single institution experience with the first 30 consecutive cases

Meta‐analysis of epidural analgesia in patients undergoing pancreatoduodenectomy

Comparison of Minimally Invasive versus Open Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma: A Propensity Score Matching Analysis

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