Advertisement

Predictors and outcomes of converted minimally invasive pancreaticoduodenectomy: a propensity score matched analysis

Abstract

Background

Data-driven patient selection guidelines are not available to optimize outcomes in minimally invasive pancreaticoduodenectomy (MIPD). We aimed to define risk factors associated with conversion from MIPD to open PD and to determine the impact of conversion on post-operative outcomes.

Methods

We conducted a retrospective review of MIPD using NSQIP from 2014 to 2015. Propensity score was used to match patients who underwent completed MIPD to converted MIPD.

Results

467 patients were included: 375 (80.3%) MIPD and 92 (19.7%) converted. Converted patients were more often male (64% vs. 52%, p = 0.030), had higher rates of dyspnea (10% vs. 3%, p = 0.009), underwent more vascular (44% vs. 14%, p < 0.001) or multivisceral resection (19% vs. 6%, p = 0.0005), and were more likely attempted laparoscopically compared to robotically (76% vs. 51%, p < 0.001). Robotic approach was independently associated with reduced risk of conversion (OR 0.40, 95% CI 0.23–0.69), while male gender (OR 1.70, 95% CI 1.02–2.84), history of dyspnea (OR 3.85, 95% CI 1.49–9.96), vascular resection (OR 4.32, 95% CI 2.53–7.37), and multivisceral resection (OR 2.18, 95% CI 1.05–4.52) were associated with increased risk. Major complications were more common in converted patients (68% vs. 37%, p < 0.001). Converted patients had increased odds of non-home discharge (OR 3.25, 95% CI 1.06–9.97) and an associated increased length of stay of 3 days (95% CI 0.1–6.7).

Conclusion

Patients with a history of dyspnea or tumors requiring vascular or multivisceral resection were at increased risk of conversion, and the robotic platform was associated with a lower rate of conversion. Conversion was independently associated with increased overall complications, increased length of stay, and non-home discharge.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

References

  1. 1.

    Gagner M, Pomp A (1994) Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 8:408–410

  2. 2.

    Melvin WS, Needleman BJ, Krause KR, Ellison EC (2003) Robotic resection of pancreatic neuroendocrine tumor. J Laparoendosc Adv Surg Tech A 13:33–36

  3. 3.

    Giulianotti PC, Coratti A, Angelini M et al (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784

  4. 4.

    Zeh HJ, Zureikat AH, Secrest A, Dauoudi M, Bartlett D, Moser AJ (2012) Outcomes after robot-assisted pancreaticoduodenectomy for periampullary lesions. Ann Surg Oncol 19:864–870

  5. 5.

    Zhang J, Wu WM, You L, Zhao YP (2013) Robotic versus open pancreatectomy: a systematic review and meta-analysis. Ann Surg Oncol 20:1774–1780

  6. 6.

    Liao CH, Wu YT, Liu YY et al (2016) Systemic review of the feasibility and advantage of minimally invasive pancreaticoduodenectomy. World J Surg 40:1218–1225

  7. 7.

    Zenoni SA, Arnoletti JP, de la Fuente SG (2013) Recent developments in surgery: minimally invasive approaches for patients requiring pancreaticoduodenectomy. JAMA Surg 148:1154–1157

  8. 8.

    Lai EC, Yang GP, Tang CN (2012) Robot-assisted laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy–a comparative study. Int J Surg 10:475–479

  9. 9.

    Kuroki T, Adachi T, Okamoto T, Kanematsu T (2012) A non-randomized comparative study of laparoscopy-assisted pancreaticoduodenectomy and open pancreaticoduodenectomy. Hepatogastroenterology 59:570–573

  10. 10.

    Chalikonda S, Aguilar-Saavedra JR, Walsh RM (2012) Laparoscopic robotic-assisted pancreaticoduodenectomy: a case-matched comparison with open resection. Surg Endosc 26:2397–2402

  11. 11.

    Asbun HJ, Stauffer JA (2012) Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System. J Am Coll Surg 215:810–819

  12. 12.

    Zureikat AH, Breaux JA, Steel JL, Hughes SJ (2011) Can laparoscopic pancreaticoduodenectomy be safely implemented? J Gastrointest Surg 15:1151–1157

  13. 13.

    Buchs NC, Addeo P, Bianco FM, Ayloo S, Benedetti E, Giulianotti PC (2011) Robotic versus open pancreaticoduodenectomy: a comparative study at a single institution. World J Surg 35:2739–2746

  14. 14.

    Chen S, Chen JZ, Zhan Q et al (2015) Robot-assisted laparoscopic versus open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study. Surg Endosc 29:3698–3711

  15. 15.

    Zhou NX, Chen JZ, Liu Q et al (2011) Outcomes of pancreatoduodenectomy with robotic surgery versus open surgery. Int J Med Robot 7:131–137

  16. 16.

    Nassour I, Wang SC, Christie A et al (2018) Minimally invasive versus open pancreaticoduodenectomy: a propensity-matched study from a national cohort of patients. Ann Surg 268:151–157

  17. 17.

    Palanivelu C, Senthilnathan P, Sabnis SC et al (2017) Randomized clinical trial of laparoscopic versus open pancreatoduodenectomy for periampullary tumours. Br J Surg 104:1443–1450

  18. 18.

    Lei P, Wei B, Guo W, Wei H (2014) Minimally invasive surgical approach compared with open pancreaticoduodenectomy: a systematic review and meta-analysis on the feasibility and safety. Surg Laparosc Endosc Percutan Tech 24:296–305

  19. 19.

    Doula C, Kostakis ID, Damaskos C et al (2016) Comparison between minimally invasive and open pancreaticoduodenectomy: a systematic review. Surg Laparosc Endosc Percutan Tech 26:6–16

  20. 20.

    Correa-Gallego C, Dinkelspiel HE, Sulimanoff I et al (2014) Minimally-invasive vs open pancreaticoduodenectomy: systematic review and meta-analysis. J Am Coll Surg 218:129–139

  21. 21.

    Speicher PJ, Nussbaum DP, White RR et al (2014) Defining the learning curve for team-based laparoscopic pancreaticoduodenectomy. Ann Surg Oncol 21:4014–4019

  22. 22.

    Langan RC, Graham JA, Chin AB et al (2014) Laparoscopic-assisted versus open pancreaticoduodenectomy: early favorable physical quality-of-life measures. Surgery 156:379–384

  23. 23.

    Bao PQ, Mazirka PO, Watkins KT (2014) Retrospective comparison of robot-assisted minimally invasive versus open pancreaticoduodenectomy for periampullary neoplasms. J Gastrointest Surg 18:682–689

  24. 24.

    Mesleh MG, Stauffer JA, Bowers SP, Asbun HJ (2013) Cost analysis of open and laparoscopic pancreaticoduodenectomy: a single institution comparison. Surg Endosc 27:4518–4523

  25. 25.

    Cho A, Yamamoto H, Nagata M et al (2009) Comparison of laparoscopy-assisted and open pylorus-preserving pancreaticoduodenectomy for periampullary disease. Am J Surg 198:445–449

  26. 26.

    Pugliese R, Scandroglio I, Sansonna F et al (2008) Laparoscopic pancreaticoduodenectomy: a retrospective review of 19 cases. Surg Laparosc Endosc Percutan Tech 18:13–18

  27. 27.

    Gumbs AA, Gres P, Madureira FA, Gayet B (2008) Laparoscopic vs. open resection of noninvasive intraductal pancreatic mucinous neoplasms. J Gastrointest Surg 12:707–712

  28. 28.

    Stiles ZE, Dickson PV, Deneve JL et al (2018) The impact of unplanned conversion to an open procedure during minimally invasive pancreatectomy. J Surg Res 227:168–177

  29. 29.

    Nassour I, Wang SC, Porembka MR et al (2017) Conversion of minimally invasive distal pancreatectomy: predictors and outcomes. Ann Surg Oncol 24:3725–3731

  30. 30.

    Improvement ACoSNSQ. User Guide for the 2015 ACS NSQIP Procedure Targeted PUF Program

  31. 31.

    Schmidt CM, Turrini O, Parikh P et al (2010) Effect of hospital volume, surgeon experience, and surgeon volume on patient outcomes after pancreaticoduodenectomy: a single-institution experience. Arch Surg 145:634–640

  32. 32.

    Menon VG, Puri VC, Annamalai AA, Tuli R, Nissen NN (2013) Outcomes of vascular resection in pancreaticoduodenectomy: single-surgeon experience. Am Surg 79:1064–1067

  33. 33.

    Croome KP, Farnell MB, Que FG et al (2015) Pancreaticoduodenectomy with major vascular resection: a comparison of laparoscopic versus open approaches. J Gastrointest Surg 19:189–194 discussion 94

  34. 34.

    Raoof M, Nota C, Melstrom LG et al (2018) Oncologic outcomes after robot-assisted versus laparoscopic distal pancreatectomy: analysis of the National Cancer Database. J Surg Oncol 118:651–656

  35. 35.

    Zureikat AH, Borrebach J, Pitt HA et al (2017) Minimally invasive hepatopancreatobiliary surgery in North America: an ACS-NSQIP analysis of predictors of conversion for laparoscopic and robotic pancreatectomy and hepatectomy. HPB (Oxford) 19:595–602

  36. 36.

    King JC, Zeh HJ 3rd, Zureikat AH et al (2016) Safety in numbers: progressive implementation of a robotics program in an academic surgical oncology practice. Surg Innov 23:407–414

  37. 37.

    Nassour I, Wang SC, Porembka MR et al (2017) Robotic versus laparoscopic pancreaticoduodenectomy: a NSQIP analysis. J Gastrointest Surg 21:1784–1792

  38. 38.

    Becker C, Plymale MA, Wennergren J, Totten C, Stigall K, Roth JS (2017) Compliance of the abdominal wall during laparoscopic insufflation. Surg Endosc 31:1947–1951

  39. 39.

    Bardoczky GI, Engelman E, Levarlet M, Simon P (1993) Ventilatory effects of pneumoperitoneum monitored with continuous spirometry. Anaesthesia 48:309–311

  40. 40.

    Beane JD, Pitt HA, Dolejs SC, Hogg ME, Zeh HJ, Zureikat AH (2018) Assessing the impact of conversion on outcomes of minimally invasive distal pancreatectomy and pancreatoduodenectomy. HPB (Oxford) 20:356–363

  41. 41.

    Kuss O, Blettner M, Borgermann J (2016) Propensity score: an alternative method of analyzing treatment effects. Dtsch Arztebl Int 113:597–603

  42. 42.

    de Rooij T, van Hilst J, Boerma D et al (2016) Impact of a nationwide training program in minimally invasive distal pancreatectomy (LAELAPS). Ann Surg 264:754–762

Download references

Acknowledgements

There was no additional help in the writing of this manuscript.

Author information

Correspondence to Rebecca M. Minter.

Ethics declarations

Disclosures

Caitlin A. Hester, Ibrahim Nassour, Alana Christie, Mathew Augustine, John C. Mansour, Patricio M. Polanco, Matthew R. Porembka, Thomas H. Shoultz, Sam C. Wang, Adam C. Yopp, Herbert J. Zeh III, Rebecca M. Minter have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hester, C.A., Nassour, I., Christie, A. et al. Predictors and outcomes of converted minimally invasive pancreaticoduodenectomy: a propensity score matched analysis. Surg Endosc 34, 544–550 (2020) doi:10.1007/s00464-019-06792-0

Download citation

Keywords

  • Minimally invasive
  • Converted
  • Pancreaticoduodenectomy
  • Predictors
  • Outcomes