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MINIMALLY INVASIVE VS OPEN DISTAL PANCREATECTOMY IN CHILDREN: A NSQIP-PEDIATRIC ANALYSIS OF OUTCOMES AND FACTORS ASSOCIATED WITH ADVERSE EVENTS
Muhammed Ali Colak^*1, Shruthi Srinivas², Yueran Zhang¹, A. J. Freeman¹, Sara K. Rasmussen¹, Kyle Van Arendonk¹, Jaimie D. Nathan^1
1Abdominal Transplant and Hepatopancreatobiliary Surgery, Nationwide Children's Hospital, Columbus, OH; ²The Ohio State University Wexner Medical Center, Columbus, OH

Objective:
We aim to evaluate the impact of minimally invasive surgery (MIS) on postoperative outcomes after pediatric distal pancreatectomy (DP) and determine factors associated with postoperative adverse events.

Methods:
Patients (age?18) undergoing DP for pancreatic diagnoses between 2013-2022 were identified using the National Surgical Quality Improvement Program-Pediatric. Preoperative demographics/comorbidities and postoperative outcomes were compared between operative approaches with an intention-to-treat analysis. Multivariable logistic regression was used to identify associations with postoperative adverse events (complication/readmission/reoperation/death).

Results:
A total of 274 patients underwent DP operations. Indications for operation included pancreas neoplasms and cysts (46.4%), hypoglycemia (28.8%), pancreatitis and pseudocysts (6.9%), and other pancreatic disorders (17.9%). MIS was utilized in 95 (32.3%) patients, of which 27 (28.4%) were converted to open. Patients with pancreatic neoplasms were more likely than those with hypoglycemia or pancreatitis/pseudocysts to undergo MIS (50.4% vs 8.9% vs 21.1%, p<0.0001). MIS was more common between 2018-2022 than 2013-2017 (41.9% vs 24.6%, p=0.003). MIS patients were older (14.6 [12.0,16.1] vs 11.1 [0.3,15.2] years, p<0.0001) and more likely to be female (80.0% vs 59.2%, p=0.0005). They less frequently had preoperative comorbidities (27.4% vs 45.8%, p=0.003), required preoperative nutritional support (3.2% vs 25.7%, p<0.0001), or had other major concurrent procedures at time of DP (4.2% vs 29.6%, p<0.0001) [Table 1]. MIS patients had longer operations (243 min vs 196 min, p=0.001), but shorter postoperative length of stay (4 days vs 8 days, p<0.0001) and fewer simple complications (4.8% vs 13.2%, p=0.044) [Table 2]. Readmissions, reoperations, and severe complications were similar. Although presence of any adverse events was lower in MIS patients (23.2% vs 35.8%, p=0.051), the difference was not statistically significant. Adjusting for age, race, diagnosis, concurrent major procedures, and comorbidities, operative technique was not associated with the occurrence of a post-operative adverse event. Odds of any adverse event were independently lower in Blacks than Whites (aOR: 0.304, 95% CI: 0.095-0.975) and higher in patients with any preoperative comorbidity (aOR: 2.64, 95% CI: 1.441-4.839).

Conclusions:
MIS use for pediatric DP has increased over time. MIS is safe, with no increase in adverse events, and may provide shorter length of stay and lower risk of simple complications compared to open DP.


Table 1 - Demographics and Preoperative Characteristics

Table 2 - Postoperative Outcomes

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