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Morbidity and survival after laparoscopic versus open pancreatoduodenectomy: propensity score matched comparison

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A Correction to this article was published on 16 February 2023

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Abstract

Purpose

Technical challenges and a perceived higher risk of complications hinder a wide adoption of minimally invasive pancreatoduodenectomy. We aim to further define the place of minimally invasive pancreatoduodenectomy by comparison with the traditional open approach.

Methods

A comparison of the surgical outcomes and survival after laparoscopic (LPD) versus open pancreatoduodenectomy (OPD) was retrospectively performed from a prospectively kept database. To reduce the effect of bias and confounding, baseline characteristics of both groups were matched using propensity score matching (NCT05110573; Nov 8, 2021; retrospectively registered).

Results

From a total of 67 LPD and 105 OPD patients, propensity score matching resulted in two balanced groups of 38 patients. In both groups, 87% of surgeries were performed for cancer. In the LPD group, conversion rate was 22.4%. Mean operative time was significantly longer after LPD versus OPD (320.1 ± 53.8 vs. 277.7 ± 63.8 min; p = .008). Hospital stay was significantly shorter after LPD versus OPD (median 13.5 vs. 17.0 days; p = .039). No significant differences were observed in blood loss, total complication rate (73.7% vs. 86.8%; p = .249), major complication rate (26.5% vs. 10.5%; p = .137), postoperative pancreatic fistula rate (13.2% vs. 7.9%; p = .711), 90-day mortality rate (5.3% vs. 0%; p = .493), R0 resection rate (85.4% vs. 85.8%), or number of lymph nodes (median 10.0 vs. 8.5; p = .273). In cancer patients, no significant differences were observed in overall survival (median 27.1 vs. 23.9 months; p = .693), disease-free survival, or recurrence rate.

Conclusion

LPD provided acceptable short-term and oncological outcomes. Compared to OPD, we noted a higher major complication rate, without compromising surgical safety or oncological outcomes.

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Abbreviations

PD:

Pancreatoduodenectomy

MIPD:

Minimally invasive pancreatoduodenectomy

RCT:

Randomized controlled trial

RPD:

Robotic pancreatoduodenectomy

LPD:

Laparoscopic pancreatoduodenectomies

OPD:

Open pancreatoduodenectomies

POPF:

Postoperative pancreatic fistula

CR-POPF:

Clinically relevant postoperative pancreatic fistula

IQR:

Interquartile range

SD:

Standard deviation

HR:

Hazard ratio

OR:

Odds ratio

ICU:

Intensive care unit

OS:

Overall survival

DFS:

Disease-free survival

DGE:

Delayed gastric emptying

PPH:

Post-pancreatectomy haemorrhage

BMI:

Body mass index

CCI:

Charlson Comorbidity Index

LOS:

Length of hospital stay

CI:

Confidence intervals

PSM:

Propensity score matching

GDA:

Gastroduodenal artery

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Authors and Affiliations

  1. Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium

    Mathieu Vandeputte, Franky Vansteenkiste, Celine De Meyere & Mathieu D’Hondt

  2. Department of Gastrointestinal Surgery, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Wim Ceelen

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Contributions

Study conception and design: MV, MDH, FV. Acquisition of data: FV, MDH, MV, CD. Analysis and interpretation of data: MV, MDH. Drafting of manuscript: MV, MDH, WC. Critical revision of manuscript: MDH, WC.

Corresponding author

Correspondence to Mathieu D’Hondt.

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The study was approved by the local ethics committee (B3962020000032). This article was written in accordance with the ethical standards of the institutional review board and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all human subjects as is the standard of care and as with compliance with institution guidelines.

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The authors declare no competing interests.

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Vandeputte, M., Vansteenkiste, F., Ceelen, W. et al. Morbidity and survival after laparoscopic versus open pancreatoduodenectomy: propensity score matched comparison. Langenbecks Arch Surg 408, 16 (2023). https://doi.org/10.1007/s00423-023-02758-y

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