An assessment of perioperative outcomes for open, laparoscopic, and robot‐assisted pancreaticoduodenectomy in New York State

• Published in: Journal of surgical oncology Vol. 126; no. 8; pp. 1434 - 1441
• Main Authors: Wach, Michael M., Myneni, Ajay A., Miller, Lorin, Boccardo, Joseph, Ibrahim‐Zada, Irada, Schwaitzberg, Steven S., Noyes, Katia, Gajdos, Csaba
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-12-2022
• Subjects: Aged; Humans; laparoscopic; Laparoscopy; Laparoscopy - methods; Length of Stay; Male; minimally invasive; New York - epidemiology; open; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy; Pancreaticoduodenectomy - methods; Postoperative Complications - etiology; Retrospective Studies; robotic; Robotics; New York; United States > US; laparoscopic; minimally invasive; pancreaticoduodenectomy; robotic; open
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.27075

Background
Minimally invasive techniques for pancreaticoduodenectomy (PD) are increasing in practice, however, data remains limited regarding perioperative outcomes. Our study sought to compare patients undergoing open pancreaticoduodenectomy (OPD) with those undergoing laparoscopic (LPD) or robot‐assisted pancreaticoduodenectomy (RPD).
Methods
Patients who underwent PD during 2016–2018 were identified from the New York State Planning and Research Cooperative System database.
Results
Of the 1954 patients identified, 1708 (87.4%) underwent OPD, 165 (8.4%) underwent LPD, and 81 (4.2%) underwent RPD. The majority of patients were White (63.8%), males (53.3%) with a mean age of 65.4 years. RPD patients had a lower median Charlson Comorbidity Index (2) than OPD (3) or LPD (3, p = 0.01) and had a lower 30‐day rate of complications (35.8% vs. 48.3% vs. 43.6% respectively, p = 0.05). After propensity‐score matching, however, there were no differences between the groups regarding overall complications, surgical site infections, anastomotic leaks, or mortality (p = NS for all). OPD demonstrated a longer length of stay (median 8 days) compared to LPD (7 days) or RPD (7 days, p < 0.01).
Conclusions
Patients undergoing LPD and RPD have a shorter length of hospital stay compared to OPD and there was no difference in overall morbidity or mortality when matched to similar patients.