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

Abstract

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.

Minimally invasive surgery for pancreatic cancer—are we there yet?—a narrative review

“…Adjuvant treatment rates were higher following MIPD (80.8% vs. 59.8%, P=0.002). The median overall survival and disease-free survival rates were similar between the groups (68).…”

Current statement and safe implementation of minimally invasive surgery in the pancreas

“…The oncologic benefit on PDAC derived from RPD remains uncertain, because of insufficient pooled data 40–43 . According to limited cohort studies, 40–43 the survival outcomes in PDAC are comparable between RPD and OPD (Table 1). In addition, there is no evidence of superiority between RPD and LPD.…”

“…From pooled data in observational studies, [32][33][34][35][36][37][38][39][40][41][42][43] MIPD for PDAC provides comparable oncologic outcomes to OPD, as in MIDP (Table 1). Both MIPD and OPD are valid approaches for selected patients with PDAC.…”

Focused ultrasound tumour ablation in small animal oncology

“…Minimally invasive procedures can decrease morbidity while yielding similar disease or oncologic outcomes. Reports of minimally invasive pancreaticoduodenectomy and liver lobectomy in human cancer patients, and of minimally invasive adrenalectomy in dogs with cancer demonstrate the perioperative benefits of minimally invasive procedures, such as decreased duration of hospital stay 7–9 . The oncologic outcomes for human patients who underwent minimally invasive pancreaticoduodenectomy and liver lobectomy did not differ from patients who underwent corresponding open procedures 7,8 .…”

“…Reports of minimally invasive pancreaticoduodenectomy and liver lobectomy in human cancer patients, and of minimally invasive adrenalectomy in dogs with cancer demonstrate the perioperative benefits of minimally invasive procedures, such as decreased duration of hospital stay 7–9 . The oncologic outcomes for human patients who underwent minimally invasive pancreaticoduodenectomy and liver lobectomy did not differ from patients who underwent corresponding open procedures 7,8 . The perioperative benefits of minimally invasive surgical procedures such as laparoscopic adrenalectomy, liver lobectomy, cholecystectomy provide the impetus for continued development of these techniques in human and veterinary oncologic surgeries.…”