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Laparoscopic Pancreaticoduodenectomy for Adenocarcinoma Results in Short-Term Oncologic Outcomes and Long-Term Overall Survival Rates Identical to those for Open Pancreaticoduodenectomy but Affords Shorter Hospitalization
Olga Kantor*1, Mark S. Talamonti2,1, Susan Sharpe1, Waseem Lutfi2, David J. Winchester2, Richard A. Prinz2, Marshall Baker2
1Surgery, University of Chicago, Chicago, IL; 2Surgery, NorthShore University HealthSystem, Evanston, IL
Background: The safety and efficacy of laparoscopic pancreaticoduodenectomy (LPD) relative to open pancreaticoduodenectomy (OPD) for adenocarincoma (PDAC) in the pancreatic head remains unclear.
Methods: The National Cancer Data Base was queried to identify patients who underwent LPD or OPD for PDAC for invasive, non-metastatic disease from 2010-2013. Laparoscopic procedures converted to open were excluded. Chi-square, multivariate regression, and Cox-survival modeling were used for analysis.
Results: 7947 (90.2%) patients underwent OPD and 867 (9.8%) underwent LPD in the four years under review. There were no statistical differences between the two surgical cohorts with regard to age, race, Charlson comorbidity index, insurance status, tumor size, pathologic grade, stage, or receipt of neoadjuvant chemotherapy or radiation. The laparoscopic cohort demonstrated a statistically shorter initial length of stay (10.3 ± 8.4 vs 11.8 ± 9.3, p<0.01) and lower rates of unplanned readmission (6.8% vs 9.3%, p=0.01) but also demonstrated higher lymph node counts (17.9 ± 9.5 vs 16.8 ± 9.7, p<0.01) and tended to have a higher rate of margin negative resection (79.5% vs 76.0%, p=0.01) than the open cohort. 30-day mortality rates were similar between groups (4.1% vs 3.8%, p=0.38). On multivariate regression analysis adjusting for age, Charlson score, tumor size, nodal positivity, stage, and facility type, patients undergoing LPD demonstrated lymph node yields and rates of margin negative resection as well as 30-day mortality identical to those undergoing OPD, but were less likely to suffer unplanned readmission (OR 0.72, p=0.02) and prolonged LOS (OR 0.74, p=0.03). Cox-regression survival analysis adjusting for age, gender, comorbidities, facility type and location, tumor stage, grade, size, nodes, margin status and treatment with chemotherapy/radiation from 2010-2012 demonstrated rates of overall survival for patients undergoing LPD to be identical to those undergoing OPD (20.6mths vs 20.9mths, p=0.88).
Conclusions: The laparoscopic approach to pancreaticoduodenectomy for patients with pancreatic cancer provides postoperative oncologic and long-term survival outcomes identical to OPD but is associated with accelerated in-patient recovery and decreased rates of postoperative readmission.
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