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Discrepancies in survival after conversion to open in minimally invasive pancreatoduodenectomy

Published:October 28, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.10.056

      Highlights

      • Minimally invasive pancreatoduodenectomy has become increasingly popular with concomitant decreases in conversion to open.
      • Conversion to open pancreatoduodenectomy is associated with a lower median overall survival than successful open operations.
      • 90-day mortality after conversion to open from minimally invasive pancreatoduodenectomy is higher at low-volume centers.
      • These data emphasize the importance of safe adoption strategies when learning minimally invasive pancreatoduodenectomy.

      Abstract

      Background

      The extent by which conversion to open (CTO) during minimally invasive procedures for pancreatic cancer impact survival outcomes is not fully understood.

      Methods

      The 2010–2017 National Cancer Database identified 12,424 non-metastatic patients who underwent pancreatoduodenectomy for ductal adenocarcinoma. Patients were stratified into three cohorts: open (OPD), completed MIPD (cMIPD), and CTO. Subgroups were dichotomized by hospital MIPD volume.

      Results

      Across the study period, 80.6% of patients underwent OPD, 19.4% MIPD, and 24% were CTO. Median overall survival was worse after CTO (21.8 months) than for OPD (23.6 months) or cMIPD (25.2 months) (p < 0.001). Although this effect persisted for <10 MIPD/year, CTO did comparably to OPD at hospitals performing ≥10MIPD/year (CTO = 26.8 months, OPD = 27.9 months; p = 0.128). Ninety-day mortality after CTO was worse at ≤ 10 MIPD/year hospitals (9.3% vs. 2.6%).

      Conclusions

      Short and long-term survival is impacted by CTO after MIPD, especially at lower surgical volumes, stressing careful adoption while ascending the learning curve.

      Graphical abstract

      Keywords

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