TY - JOUR
T1 - Minimally invasive pancreaticoduodenectomy
T2 - A favorable approach for frail patients with pancreatic cancer
AU - Farah, Emile
AU - Al Abbas, Amr
AU - Abreu, Andres A.
AU - Cheng, Mingyuan
AU - Yopp, Adam
AU - Wang, Sam
AU - Mansour, John
AU - Porembka, Matthew
AU - Zeh, Herbert J.
AU - Polanco, Patricio M.
N1 - Publisher Copyright:
© 2023
PY - 2024/4
Y1 - 2024/4
N2 - Background: Within the past decade, minimally invasive pancreaticoduodenectomy has been increasingly adopted in high-volume cancer centers. Amid broader trends of a growing older population, the numbers of frail patients with cancer are expected to increase. In this study, we compared the postoperative outcomes of open pancreaticoduodenectomy and minimally invasive pancreaticoduodenectomy in frail patients with pancreatic ductal adenocarcinoma. Methods: Using the pancreatectomy-targeted American College of Surgeons–National Surgical Quality Improvement Program database (2014–2021), we identified pancreaticoduodenectomy cases for pancreatic ductal adenocarcinoma. Patients with a modified frailty index ≥2 were considered frail. We performed 2:1 (open pancreaticoduodenectomy to minimally invasive pancreaticoduodenectomy) optimal pair propensity score matching for both patient- and disease-specific characteristics. We evaluated baseline covariate balance for homogeneity and assessed 30-day postoperative outcomes: complications, discharge destination, major morbidity, and mortality. Results: We identified 3,143 frail patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. Of those, 275 (9%) underwent minimally invasive pancreaticoduodenectomy. Minimally invasive pancreaticoduodenectomy was associated with a lower rate of any complications compared with open pancreaticoduodenectomy (43% vs 54%; P <.001), major morbidity (29% vs 35%; P =.042), and nonhome discharge (12% vs 17%; P =.022). When comparing the 2 minimally invasive pancreaticoduodenectomy approaches, robotic surgery was associated with fewer complications compared with laparoscopy (39% vs 51%; P =.040) and a lower mortality rate (1% vs 4%; P =.041) Conclusion: In frail patients with pancreatic cancer, minimally invasive pancreaticoduodenectomy was associated with better postoperative outcomes than open pancreaticoduodenectomy. This study builds on growing literature reporting that, when properly implemented, minimally invasive pancreaticoduodenectomy is associated with more favorable postoperative outcomes. Given the particularly high risk of complication in frail patients, implementing a preoperative frailty assessment can provide valuable insights to inform patient counseling.
AB - Background: Within the past decade, minimally invasive pancreaticoduodenectomy has been increasingly adopted in high-volume cancer centers. Amid broader trends of a growing older population, the numbers of frail patients with cancer are expected to increase. In this study, we compared the postoperative outcomes of open pancreaticoduodenectomy and minimally invasive pancreaticoduodenectomy in frail patients with pancreatic ductal adenocarcinoma. Methods: Using the pancreatectomy-targeted American College of Surgeons–National Surgical Quality Improvement Program database (2014–2021), we identified pancreaticoduodenectomy cases for pancreatic ductal adenocarcinoma. Patients with a modified frailty index ≥2 were considered frail. We performed 2:1 (open pancreaticoduodenectomy to minimally invasive pancreaticoduodenectomy) optimal pair propensity score matching for both patient- and disease-specific characteristics. We evaluated baseline covariate balance for homogeneity and assessed 30-day postoperative outcomes: complications, discharge destination, major morbidity, and mortality. Results: We identified 3,143 frail patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. Of those, 275 (9%) underwent minimally invasive pancreaticoduodenectomy. Minimally invasive pancreaticoduodenectomy was associated with a lower rate of any complications compared with open pancreaticoduodenectomy (43% vs 54%; P <.001), major morbidity (29% vs 35%; P =.042), and nonhome discharge (12% vs 17%; P =.022). When comparing the 2 minimally invasive pancreaticoduodenectomy approaches, robotic surgery was associated with fewer complications compared with laparoscopy (39% vs 51%; P =.040) and a lower mortality rate (1% vs 4%; P =.041) Conclusion: In frail patients with pancreatic cancer, minimally invasive pancreaticoduodenectomy was associated with better postoperative outcomes than open pancreaticoduodenectomy. This study builds on growing literature reporting that, when properly implemented, minimally invasive pancreaticoduodenectomy is associated with more favorable postoperative outcomes. Given the particularly high risk of complication in frail patients, implementing a preoperative frailty assessment can provide valuable insights to inform patient counseling.
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U2 - 10.1016/j.surg.2023.12.022
DO - 10.1016/j.surg.2023.12.022
M3 - Article
C2 - 38307784
AN - SCOPUS:85184032461
SN - 0039-6060
VL - 175
SP - 1168
EP - 1175
JO - Surgery (United States)
JF - Surgery (United States)
IS - 4
ER -