DOES A LAPAROSCOPIC APPROACH TO DISTAL PANCREATECTOMY FOR CANCER CONTRIBUTE TO OPTIMAL CHEMOTHERAPY UTILIZATION?
Omid Salehi*1, Eduardo A. Vega1, Onur C. Kutlu2, Sandeep Krishnan1, Sylvia V. Alarcon1, Vera Kazakova1, Olga Kozyreva1, Claudius Conrad1
1Saint Elizabeth's Medical Center, Brighton, MA; 2University of Miami School of Medicine, Miami, FL
Background: While Laparoscopic Distal Pancreatectomy (LDP) versus open approaches (ODP) for pancreatic adenocarcinoma (PDAC) is associated with reduced morbidity, its impact on optimal adjuvant chemotherapy (AC) utilization remains unclear. Further, it's uncertain whether oncologic resection quality markers are equivalent between approaches.
Methods: The National Cancer Database (NCDB) was queried between 2010-2016 for PDAC undergoing DP with complete data. Effect of LDP vs ODP and institutional case volumes on margin status, hospital stay, 30-day and 90-day mortality, administration of and delay to AC, and 30-day unplanned readmission were analyzed using binary and linear logistic regression. Cox multivariable regression was used to correct for confounders.
Results: The search yielded 3411 patients; 996 (29.2%) had LDP and 2415 (70.8%) had ODP. ODP had higher odds of unplanned 30-day readmission [OR 1.681, p=0.01] and longer hospital stay [β 1.745, p=0.004]. No difference was found for 30-day mortality [OR 1.689, p=0.303], 90-day mortality [OR 1.936, p=0.207], and overall survival [HR 1.231, p=0.057]. The highest volume centers had improved odds of AC [OR 1.275, p=0.027] regardless of approach. LDP conferred lower margin positivity [OR 0.581, p=0.005], increased AC use [3rd quartile: OR 1.844, p=0.026; 4th quartile; OR 2.144, p=0.045] and fewer AC delays [4th quartile: OR 0.786, p=0.045] in higher volume centers.
Conclusion: LDP offers an oncologically safe alternative to ODP for PDAC independent of institutional volume. However, additional oncologic benefit due to optimal AC utilization and lower positive margin rates in higher volume centers suggests LDP by experienced teams can achieve best possible cancer outcomes.
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