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

• Published in: Journal of surgical oncology Vol. 122; no. 7; pp. 1383 - 1392
• Main Authors: Watson, Michael D., Baimas‐George, Maria R., Thompson, Kyle J., Iannitti, David A., Ocuin, Lee M., Baker, Erin H., Martinie, John B., Vrochides, Dionisios
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-12-2020
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - surgery; Adult; Aged; Chemotherapy; Databases, Factual; Female; Humans; laparoscopy; Male; Middle Aged; minimally invasive surgical procedures; Minimally Invasive Surgical Procedures - methods; mortality; Outcome Assessment, Health Care; Pancreatectomy; Pancreatectomy - methods; Pancreatic cancer; pancreatic neoplasm; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - surgery; Propensity Score; Robotic Surgical Procedures; laparoscopy; pancreatic neoplasm; robotic surgical procedures; mortality; minimally invasive surgical procedures; pancreatectomy
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.26147

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.