Improved oncologic outcomes for minimally invasive left pancreatectomy: Propensity‐score matched analysis of the National Cancer Database

Abstract

Background and objectives: Minimally invasive (MIS) left pancreatectomy (LP) is increasingly used to treat pancreatic adenocarcinoma (PDAC). Despite improved short-term outcomes, no studies have demonstrated long-term benefits over open resection. Methods: The National Cancer Database was queried between 2010 and 2016 for patients with PDAC, grouped by surgical approach (MIS vs open). Demographics, comorbidities, clinical staging, and pathologic staging were used for propensity-score matching. Perioperative, short-term oncologic, and survival outcomes were compared. Results: After matching, both cohorts included 805 patients. There were no differences in baseline characteristics, staging, or preoperative therapy between cohorts. The MIS cohort had a shorter length of stay (6.8 ± 5.5 vs 8.5 ± 7.3 days; P < .0001) with the trend toward improved time to chemotherapy (53.9 ± 26.1 vs 57.9 ± 29.9 days; P = .0511) and margin-positive resection rate (15.3% vs 18.9%; P = .0605). Lymph node retrieval and receipt of chemotherapy were similar. The MIS cohort had higher median overall survival (28.0 vs 22.1 months; P = .0067). Subgroup analysis demonstrated the highest survival for robotic compared with laparoscopic and open LP (41.9 vs 26.6 vs 22.1 months; P < .0001). Conclusions: This study demonstrates the safety of MIS LP and favorable long-term oncologic outcomes. The improved survival after MIS LP warrants further study with prospective, randomized trials.

The current status and future directions of robotic pancreatectomy

“…Qu et al38 analyzed only cases of PDAC with PSM and showed significantly lower conversion rates in RDP than in LDP (5.7% and 22.9%, P = .04). Watson et al49 analyzed the NCDB and showed the same results (15.2% in RDP vs 24.4% in LDP, P = .016). Thus, RDP is favorable in terms of lower rates of conversion to laparotomy and comparable postoperative outcomes.…”

“…In one of these three reports, Liu et al34 reported that the conversion rates were significantly lower in association with RDP than with LDP (2.9% and 9.8%, P = .045), while De et al40 showed no significant difference.Qu et al38 analyzed only cases of PDAC with PSM and showed significantly lower conversion rates in RDP than in LDP (5.7% and 22.9%, P = .04). Watson et al49 analyzed the NCDB and showed the same results (15.2% in RDP vs 24.4% in LDP, P = .016).…”

Robotic-assisted pancreatic surgery in the elderly patient: experiences from a high-volume centre

“…RPS is one of the latest advances in minimally invasive surgery and receives a lot of attention [6]. Mainly for distal pancreatectomies published results of RPS seem promising, also with respect to the oncological outcomes [5]. Moreover, The International Study Group on Minimally Invasive Pancreatic Surgery documented that minimally invasive distal pancreatectomy may be superior to open surgery in selected cases [3].…”

“…For example, benign or low-grade malignant tumors of the pancreatic tail are mainly addressed by minimally invasive distal pancreatectomy [3]. Furthermore, Watson et al demonstrated an improved oncological outcome in patients undergoing minimally invasive procedures for malignant indications [5].…”

Chinese expert consensus on minimally invasive radical surgery for pancreatic ductal adenocarcinoma (version 2022)

“…Retrospective studies using NCDB by Raoof et al [34] and Watson et al [31] found that RDP had a lower conversion rate than LDP but no statistical differences in hospital stay and 90-day mortality for PDAC. The single-center retrospective study reported that RDP might have longer operative time than LDP but no statistical differences in intraoperative blood loss and postoperative pancreatic fistula for PDAC.…”