Highlights
- •The minimally invasive approach to pancreatoduodenectomy can decrease morbidity even though it was associated with longer operative times.
- •Operation length significantly correlated with postoperative morbidity.
- •Our data reveals that prolongation of operative times should not prohibit minimally invasive approach in pancreas surgery.
Abstract
Objectives
We aim to investigate the impact of the operation time for pancreatoduodenectomy (PD)
in different surgical approaches.
Methods
The NSQIP database was used to examine the clinical data of patients underwent PD
during 2014–2016.
Results
We sampled a total of 6151 patients who underwent elective PD. Of these, 452(7.3%)
had minimally invasive approaches to PD. Minimally invasive approaches (MIS) to PD
was associated with a significant decrease in morbidity of patients (AOR: 0.67, P < 0.01).
Following risk adjustment for morbidity predictors, operation length was statistically
associated with post-operative morbidity (AOR: 1.002, P < 0.01). Although MIS procedures
were significantly longer operations compared to open procedures (443 min vs. 371
min, CI: 53–82 min, P < 0.01), MIS approaches were associated with significantly decreased
morbidity in low stage tumors (stage zero-II) (51.3% vs. 56.2%, AOR: 0.72, P = 0.03)
and advanced stage disease (stage III-IV) (50% vs. 60.3%, AOR: 0.38, P = 0.04).
Conclusion
Minimally invasive approaches to PD were associated with decreased post-operative
morbidity, even though they were associated with longer operative times. Operation
length also significantly correlated with postoperative morbidity.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Variations in laparoscopic colectomy utilization in the United States.Dis Colon Rectum. 2015; 58: 950-956
- Comparison of open, laparoscopic, and robotic approaches for total abdominal colectomy.Surg Endosc. 2016; 30: 2792-2798
- Outcomes of open, laparoscopic, and robotic abdominoperineal resections in patients with rectal cancer.Dis Colon Rectum. 2015; 58: 1123-1129
- Contemporary review of minimally invasive pancreaticoduodenectomy.World J Gastrointest Surg. 2016; 8: 784-791
- Patient outcomes after total pancreatectomy: a single centre contemporary experience.HPB (Oxford). 2009; 11: 483-492
- A systematic review on robotic pancreaticoduodenectomy.Surg Oncol. 2013; 22: 238-246
- One thousand consecutive pancreaticoduodenectomies.Ann Surg. 2006; 244: 10-15
- The first decade of laparoscopic pancreaticoduodenectomy in the United States: costs and outcomes using the nationwide inpatient sample.Surg Endosc. 2016; 30: 1778-1783
- Comparison between minimally invasive and open pancreaticoduodenectomy: a systematic review.Surg Laparosc Endosc Percutaneous Tech. 2016; 26: 6-16
- Development of minimally invasive pancreatic surgery: an evidence-based systematic review of laparoscopic versus robotic approaches.J Gastrointest Surg. 2016; 20: 1658-1665
- Robotic versus open pancreaticoduodenectomy: a comparative study at a single institution.World J Surg. 2011; 35: 2739-2746
- Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System.J Am Coll Surg. 2012; 215: 810-819
- Cost analysis of open and laparoscopic pancreaticoduodenectomy: a single institution comparison.Surg Endosc. 2013; 27: 4518-4523
- National Surgical Quality Improvement Program [home Page on the Internet] Chicago. IL: American College of Surgeons, 2005 ([cited 2012 Jan 17]. Available from:)
- Does speed matter? The impact of operative time on outcome in laparoscopic surgery.Surg Endosc. 2011; 25: 2288-2295
- Surgical site infection prevention: the importance of operative duration and blood transfusion–results of the first American College of surgeons-national surgical quality improvement program best practices initiative.J Am Coll Surg. 2008; 207: 810-820
- Laparoscopic colon surgery: does operative time matter?.Dis Colon Rectum. 2009; 52: 1746-1752
- Practice patterns and outcomes of open and minimally invasive partial nephrectomy since the introduction of robotic partial nephrectomy: results from the nationwide inpatient sample.J Urol. 2014; 191: 907-912
- National trends with a laparoscopic liver resection: results from a population-based analysis.HPB (Oxford). 2015; 17: 919-926
- Robot-assisted pancreatic surgery: a systematic review of the literature.HPB (Oxford). 2013; 15: 1-10
- Pancreaticoduodenal resection.J Hepatobiliary Pancreat Surg. 2000; 7: 21-27
- Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches?.Ann Surg. 2014; 260 (discussion 638–640): 633-638
- Robot-assisted laparoscopic versus open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study.Surg Endosc. 2015; 29: 3698-3711
- Robotic-assisted versus laparoscopic colorectal surgery: a meta-analysis of four randomized controlled trials.World J Surg Oncol. 2014; 12: 122
- Outcomes after robot-assisted pancreaticoduodenectomy for periampullary lesions.Ann Surg Oncol. 2012; 19: 864-870
- Surgical management of rectal prolapse: the role of robotic surgery.World J Surg Proced. 2015; 5: 99-105
- Robotic-assisted pelvic organ prolapse surgery.Surg Endosc. 2005; 19: 1200-1203
- Robotic-assisted versus laparoscopic cholecystectomy: outcome and cost analyses of a case-matched control study.Ann Surg. 2008; 247: 987-993
- Postoperative pancreatic fistula: an international study group (ISGPF) definition.Surgery. 2005; 138: 8-13
- Laparoscopic robotic-assisted pancreaticoduodenectomy: a case-matched comparison with open resection.Surg Endosc. 2012; 26: 2397-2402
- Comparison of laparoscopy-assisted and open pylorus-preserving pancreaticoduodenectomy for periampullary disease.Am J Surg. 2009; 198: 445-449
- Improved survival following pancreaticoduodenectomy to treat adenocarcinoma of the pancreas: the influence of operative blood loss.Arch Surg. 2008; 143: 1166-1171
Article info
Publication history
Published online: April 18, 2018
Accepted:
April 16,
2018
Received in revised form:
April 13,
2018
Received:
November 1,
2017
Footnotes
☆Presented as a poster presentation at the Americas Hepato-Pancreato-Biliary Association annual meeting, March 29 – April 2, 2017, Miami Beach, FL, USA.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
