Reduced morbidity with minimally invasive distal pancreatectomy for pancreatic adenocarcinoma
| Autor: | Henry A. Pitt, Taylor S. Riall, Eugene P. Ceppa, Ben L. Zarzaur, Anastasia Plotkin, Elizabeth M. Kilbane |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Databases Factual Gastroenterology Sepsis Surgical pathology 03 medical and health sciences 0302 clinical medicine Pancreatectomy Postoperative Complications Robotic Surgical Procedures Risk Factors Internal medicine Surgical site medicine Carcinoma Humans Aged Hepatology Gastric emptying business.industry General surgery medicine.disease United States Pancreatic Neoplasms Treatment Outcome Pancreatic fistula 030220 oncology & carcinogenesis Adenocarcinoma 030211 gastroenterology & hepatology Female Laparoscopy business Distal pancreatectomy Carcinoma Pancreatic Ductal |
| Zdroj: | HPB : the official journal of the International Hepato Pancreato Biliary Association. 19(3) |
| ISSN: | 1477-2574 |
| Popis: | Background Minimally invasive distal pancreatectomy (MISDP) has been shown to be safe relative to open distal pancreatectomy (ODP). However, MISDP has been slow to adopt for pancreatic adenocarcinoma (PDAC). This study sought to compare outcomes following MISDP vs. ODP for PDAC. Methods Data were prospectively collected from 2011 to 2014 for DP by the American College of Surgeons-National Surgical Quality Improvement Program. Patients without PDAC on surgical pathology were excluded. Impact of minimally invasive approach on morbidity and mortality was analyzed using two-way statistical analyses. Results Of 6198 patients undergoing DP, 501 (7.5%) had a pathologic diagnosis of PDAC. MISDP was undertaken in 166 (33.1%) patients, ODP was performed in 335 (66.9%). MISDP and ODP were not different in preoperative comorbidities or pathologic stage. Overall morbidity (MISDP 31%, ODP 42%; p = 0.024), transfusion (MISDP 6%, ODP 23%; p = 0.0001), pneumonia (MISDP 1%, ODP 7%; p = 0.004), surgical site infections (MISDP 8%, OPD 17%; p = 0.013), sepsis (MISDP 2%, ODP 8%; p = 0.007), and length of stay (MISDP 5.0 days, ODP 7.0 days; p = 0.009) were lower in the MIS group. Mortality (MISDP 0%, ODP 1%; p = 0.307), pancreatic fistula (MISDP 12%, ODP 19%; p = 0.073), and delayed gastric emptying (MISDP 3%, ODP 7%; p = 0.140) were similar. Conclusions This analysis of a large multi-institution North American experience of DP for treatment of pancreatic adenocarcinoma suggests that short-term postoperative outcomes are improved with MISDP. |
| Databáze: | OpenAIRE |
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