Ann Hepatobiliary Pancreat Surg.  2023 Aug;27(3):292-300. 10.14701/ahbps.22-101.

Impact of conversion at time of minimally invasive pancreaticoduodenectomy on perioperative and long-term outcomes: Review of the National Cancer Database

• Palacio J
• Sanchez D
• Samuels S
• Ainuz BY
• Vigue RM
• Hernandez WE
• Gannon CJ
• Llaguna OH

• KMID: 2545776
• DOI: http://doi.org/10.14701/ahbps.22-101

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.

Keyword

Minimally invasive surgery; Robotic surgery; Pancreaticoduodenectomy; Pancreatic cancer; National Cancer Database

Figure

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  Fig. 1 Overall Survival by pancreaticoduodenectomy surgical approach. KM, Kaplan-Meier.

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  Fig. 2 Overall survival by case volume per year quartiles. KM, Kaplan-Meier.

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