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Laparoscopic v. open pancreaticoduodenectomy: initial institutional experience and NSQIP-matched analysis
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Laparoscopic v. open pancreaticoduodenectomy: initial institutional experience and NSQIP-matched analysis
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Laparoscopic v. open pancreaticoduodenectomy: initial institutional experience and NSQIP-matched analysis
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Journal Article
Laparoscopic v. open pancreaticoduodenectomy: initial institutional experience and NSQIP-matched analysis
2022
Overview
Background: Laparoscopic pancreaticoduodenectomy (PD) is an emerging surgical technique in Canada. Perioperative outcomes associated with initial Canadian institutional experience with this technique have not been described. This study describes our institutional experience and compares perioperative outcomes of laparoscopic PD to National Surgical Quality Improvement Program (NSQIP)-reported open PD cases using a propensity-score-matched (PSM) analysis. Methods: Institutional data were collected prospectively from sequential laparoscopic PD patients between 2019 and 2022. PSM was performed using the subset of patients undergoing open PD identified in the 2020 NSQIP procedure targeted Participant Use Data File (PUF) for pancreatectomy, which was merged with the 2020 main NSQIP PUF to include perioperative outcomes. Institutional and NSQIP data were matched on age, sex, body mass index, comorbidities, pathology, pancreatic duct diameter and gland texture. Results: Sixty laparoscopic PD were performed at our institution from 2019 to 2020; 33% (n = 20) were converted to open. On PSM analysis, there was no significant difference between laparoscopic and open PD for length of stay (11.4 d v. 8.5 d, 95% confidence interval [CI] -0.49 to -6.38, p = 0.09), postoperative pancreatic fistula (39.6% v. 22.6%, 95% CI -0.94 to 34.8, p = 0.063), delayed gastric emptying (9.4% v. 15.1, 95% CI -18.9 to 7.6, p = 0.4), superficial surgical site infections (SSIs) (11.3% v. 5.6%, 95% CI -5.3 to 16.6, p = 0.31), deep SSIs (18.7% v. 15.1%, 95% CI -10 to 17.6, p = 0.59), 30-day readmission (24.5% v. 18.9%, 95% CI -9.5 to 20.8, p = 0.47), or 30-day mortality (3.8% v. 3.8%). Laparoscopic PD was associated with higher 30-day reoperation rate (13.2% v. 1.9%, 95% CI 1.3 to 21.3, p = 0.03). Conclusion: Laparoscopic PD remains in the early stage of the learning curve. Despite equivalence to open PD in the majority of outcomes, improvement must be made in reoperation rates. Ongoing analysis is needed to elucidate whether outcomes become superior as the technique refines over time.
Publisher
CMA Impact, Inc
Subject
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