Minimally Invasive Surgery is Associated with an Increased Risk of Postoperative Venous Thromboembolism After Distal Pancreatectomy

  • Brent A. Willobee
  • Austin R. Dosch
  • Casey J. Allen
  • Francisco I. Macedo
  • Tyler S. Bartholomew
  • Omar Picado
  • Alex A. Gaidarski
  • Vikas Dudeja
  • Danny Yakoub
  • Nipun B. MerchantEmail author
Pancreatic Tumors



Venous thromboembolism (VTE) is a major cause of morbidity and mortality following distal pancreatectomy (DP). However, the influence of operative technique on VTE risk after DP is unknown.


The purpose of this study was to examine the association between the MIS technique versus the open technique and the development of postoperative VTE after DP.


Patients who underwent DP from 2014 to 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program pancreas-specific database. Multivariable logistic regression was then used to identify independent associations with the development of postoperative VTE after DP.


A total of 3558 patients underwent DP during this time period. Of these cases, 47.8% (n = 1702) were performed via the MIS approach. After adjusting for significant covariates, the MIS approach was independently associated with the development of any VTE (odds ratio [OR] 1.60, 95% confidence interval [CI] 1.06–2.40; p = 0.025), as well as increasing the risk of developing a postdischarge VTE (OR 1.80, 95% CI 1.05–3.08; p = 0.033) when compared with the open approach. There was an association between VTE and the development of numerous postoperative complications, including pneumonia, unplanned intubation, need for prolonged mechanical ventilation, and cardiac arrest.


Compared with the open approach, the MIS approach is associated with higher rates of postoperative VTE in patients undergoing DP. The majority of these events are diagnosed after hospital discharge.



Special acknowledgment must go to Deukwoo Kwon, PhD, Biostatistics and Bioinformatics Shared Resource, Sylvester Comprehensive Cancer Center, Miami, FL, USA.


Brent A. Willobee, Austin R. Dosch, Casey J. Allen, Francisco I. Macedo, Tyler S. Bartholomew, Omar Picado, Alex A. Gaidarski, Vikas Dudeja, Danny Yakoub, and Nipun B. Merchant have no relevant financial or commercial interests to disclose.


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Copyright information

© Society of Surgical Oncology 2020

Authors and Affiliations

  • Brent A. Willobee
    • 1
  • Austin R. Dosch
    • 1
  • Casey J. Allen
    • 2
  • Francisco I. Macedo
    • 3
  • Tyler S. Bartholomew
    • 4
  • Omar Picado
    • 1
  • Alex A. Gaidarski
    • 1
  • Vikas Dudeja
    • 5
    • 6
  • Danny Yakoub
    • 7
  • Nipun B. Merchant
    • 5
    • 6
    Email author
  1. 1.Department of SurgeryUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Division of Surgery, Surgical OncologyUniversity of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of Surgery, Surgical OncologyUniversity of Central Florida College of MedicineOrlandoUSA
  4. 4.University of Miami Miller School of MedicineMiamiUSA
  5. 5.Division of Surgical Oncology, Department of Surgery, Jackson Memorial Hospital/Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiUSA
  6. 6.Sylvester Comprehensive Cancer CenterMiamiUSA
  7. 7.Department of Surgery, Surgical OncologyUniversity of Tennessee Health Science Center College of Medicine MemphisMemphisUSA

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