|
|
Back to 2016 Annual Meeting
Laparoscopic Distal Pancreatectomy for Adenocarcinoma Results in Short-Term Oncologic Outcomes and Long-Term Survival Rates Identical to Open Distal Pancreatectomy but Affords Shorter Hospitalization
Olga Kantor*1, Mark S. Talamonti2, 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: Studies evaluating the efficacy of the laparoscopic approach to distal pancreatectomy (LDP) for pancreatic ductal adenocarcinoma (PDAC) generally examine short-term perioperative outcomes. There is little evidence comparing long term overall survival for patients undergoing LDP for PDAC to that for patients undergoing the gold standard of open distal pancreatectomy (ODP).
Methods: The National Cancer Data Base was queried to identify patients treated surgically with laparoscopic or open distal pancreatectomy for invasive, non-metastatic PDAC from 2010-2013. Chi-square, independent t-tests, multivariate regression, and Cox-survival modeling were used for analysis.
Results: 1554 patients underwent distal pancreatectomy for PDAC: 349 (22.5%) underwent LDP and 1205 (77.5%) ODP. The utilization of LDP increased over the period under review from 20.0% of cases in 2010 to 28.3% in 2013 (p=0.03). There were no statistical differences between surgical groups with regard to age, demographics, and Charlson comorbidity index, tumor size, node positivity and pathologic stage of disease (p>0.05). Patients undergoing LDP were less likely to receive neoadjuvant chemotherapy (5.4% vs 11.1%, p<0.01) and radiation (2.9% vs 6.6%, p=0.03) than those undergoing ODP. LDP demonstrated a higher rate of margin negative resection than ODP (85.4% vs 76.6%, p<0.01) and provided a lymphadenectomy that was identical to that for ODP (13.5 ± 9.8 vs 14.3 ± 10.6, p=0.48). Patients undergoing LDP had rates of unplanned readmission (7.7% vs 8.8%, p=0.47) and 90-day mortality (3.6% vs 5.5%, p=0.25) identical to ODP but had an initial postoperative hospital stay that was significantly shorter (7.1 ± 6.0 vs 8.7 ± 7.3, p=0.01) than those undergoing ODP. In multivariate regression analyses controlling for age, patient demographics and comorbid disease characteristics, patients undergoing LDP demonstrated identical probabilities of an adequate lymph node sampling (≥12 nodes) and 90-day mortality relative to those undergoing ODP but also demonstrated an increased probability of margin-negative resection (OR 1.78, CI 1.25-2.52) and a decreased probability of prolonged hospital stay (OR 0.55, CI 0.32-0.95) and readmission (OR 0.56, CI 0.33-0.95). Cox-regression survival modeling adjusted for age, gender, race, comorbidity, facility type and location, tumor stage, grade, size, node positivity, and postoperative chemo/radiotherapy from 2010-2012 demonstrated no difference in overall survival between patients undergoing LPD and those undergoing OPD (29.6 months vs 23.8 months, p=0.10).
Conclusions: LDP is an effective modality for managing resectable cancer in the pancreatic body and tail. LDP provides short-term oncologic outcomes and long-term overall survival rates identical to those for the gold standard ODP while affording a shorter hospitalization.
Back to 2016 Annual Meeting
|
