Risk factors for complications in patients undergoing pancreaticoduodenectomy: A NSQIP analysis with propensity score matching.
Aged
Carcinoma, Pancreatic Ductal
/ mortality
Cohort Studies
Female
Humans
Logistic Models
Male
Middle Aged
Minimally Invasive Surgical Procedures
/ adverse effects
Morbidity
Pancreatic Neoplasms
/ mortality
Pancreaticoduodenectomy
/ adverse effects
Postoperative Complications
/ epidemiology
Propensity Score
Retrospective Studies
Risk Factors
Treatment Outcome
laparoscopic
minimally Invasive
pancreas
pancreaticoduodenectomy
robotics
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
received:
03
04
2020
accepted:
05
04
2020
pubmed:
24
5
2020
medline:
12
8
2020
entrez:
24
5
2020
Statut:
ppublish
Résumé
Reports on the safety of minimally invasive pancreaticoduodenectomy compared to open pancreaticoduodenectomy (OPD) have demonstrated mixed results. One study comparing robotic pancreaticoduodenectomy (RPD) vs OPD demonstrated decreased complications associated with RPD. To evaluate the morbidity of RPD vs OPD using a national data set. This is a retrospective cohort study from 2014 to 2017. Factors associated with complications in patients undergoing pancreaticoduodenectomy were evaluated using multivariate logistic regression (MVA) and propensity score matching (PSM). Of 13 110 PDs performed over the study period, 12 612 (96.2%) were OPD and 498 (3.8%) were RPD. Patients who underwent RPD vs OPD were less likely to have any complications (46.8% vs 53.3%; P = .004), surgical complications (42.6% vs 48.6%; P = .008), wound complications (6.2% vs 9.1%; P = .029), clinically relevant postoperative pancreatic fistulas (11.9% vs 15.6%; P = .026), sepsis (6.2% vs 9.3%; P = .019), and pneumonia (1.6% vs 3.8%; P = .012). On MVA, OPD was associated with increased complications compared with RPD. On PSM analysis, OPD remained a significant predictor for any (OR, 1.29; 95% CI, 1.03-1.61; P = .029) and surgical (OR, 1.26; 95% CI, 1.00-1.58; P = .048) complications. This is the largest multicenter study to evaluate the impact of RPD on morbidity and suggests RPD is associated with decreased morbidity.
Sections du résumé
BACKGROUND
BACKGROUND
Reports on the safety of minimally invasive pancreaticoduodenectomy compared to open pancreaticoduodenectomy (OPD) have demonstrated mixed results. One study comparing robotic pancreaticoduodenectomy (RPD) vs OPD demonstrated decreased complications associated with RPD.
OBJECTIVES
OBJECTIVE
To evaluate the morbidity of RPD vs OPD using a national data set.
METHODS
METHODS
This is a retrospective cohort study from 2014 to 2017. Factors associated with complications in patients undergoing pancreaticoduodenectomy were evaluated using multivariate logistic regression (MVA) and propensity score matching (PSM).
RESULTS
RESULTS
Of 13 110 PDs performed over the study period, 12 612 (96.2%) were OPD and 498 (3.8%) were RPD. Patients who underwent RPD vs OPD were less likely to have any complications (46.8% vs 53.3%; P = .004), surgical complications (42.6% vs 48.6%; P = .008), wound complications (6.2% vs 9.1%; P = .029), clinically relevant postoperative pancreatic fistulas (11.9% vs 15.6%; P = .026), sepsis (6.2% vs 9.3%; P = .019), and pneumonia (1.6% vs 3.8%; P = .012). On MVA, OPD was associated with increased complications compared with RPD. On PSM analysis, OPD remained a significant predictor for any (OR, 1.29; 95% CI, 1.03-1.61; P = .029) and surgical (OR, 1.26; 95% CI, 1.00-1.58; P = .048) complications.
CONCLUSIONS
CONCLUSIONS
This is the largest multicenter study to evaluate the impact of RPD on morbidity and suggests RPD is associated with decreased morbidity.
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
183-194Informations de copyright
© 2020 Wiley Periodicals, Inc.
Références
Cameron JL, Riall TS, Coleman J, Belcher KA. One thousand consecutive pancreaticoduodenectomies. Ann Surg. 2006;244(1):10-15. https://doi.org/10.1097/01.sla.0000217673.04165.ea
Hyder O, Dodson RM, Nathan H, et al. Influence of patient, physician, and hospital factors on 30-day readmission following pancreatoduodenectomy in the United States. JAMA Surg. JAMA surgery. 2013;148(12):1095-1102. https://doi.org/10.1001/jamasurg.2013.2509
Dokmak S, Ftériche FS, Aussilhou B, et al. The largest European single-center experience: 300 laparoscopic pancreatic resections. J Am Coll Surg. 2017;225(2):226-234.e2. https://doi.org/10.1016/j.jamcollsurg.2017.04.004
Speicher PJ, Nussbaum DP, White RR, et al. Defining the learning curve for team-based laparoscopic pancreaticoduodenectomy. Ann Surg Oncol. 2014;21(12):4014-4019. https://doi.org/10.1245/s10434-014-3839-7
Wang M, Meng L, Cai Y, et al. Learning curve for laparoscopic pancreaticoduodenectomy: a CUSUM analysis. J Gastrointest Surg. 2016;20(5):924-935. https://doi.org/10.1007/s11605-016-3105-3
Kim SC, Song KB, Jung YS, et al. Short-term clinical outcomes for 100 consecutive cases of laparoscopic pylorus-preserving pancreatoduodenectomy: improvement with surgical experience. Surg Endosc. 2013;27(1):95-103. https://doi.org/10.1007/s00464-012-2427-9
Nagakawa Y, Nakamura Y, Honda G, et al. Learning curve and surgical factors influencing the surgical outcomes during the initial experience with laparoscopic pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci. 2018;25(11):498-507. https://doi.org/10.1002/jhbp.586
Napoli N, Kauffmann EF, Palmeri M, et al. The learning curve in robotic pancreaticoduodenectomy. Dig Surg. 2016;33(4):299-307. https://doi.org/10.1159/000445015v
Takahashi C, Shridhar R, Huston J, Meredith K. Outcomes associated with robotic approach to pancreatic resections. J Gastrointest Oncol. 2018;9(5):936-941. https://doi.org/10.21037/jgo.2018.08.04
Chen S, Chen JZ, Zhan Q, et al. Robot-assisted laparoscopic versus open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study. Surg Endosc. 2015;29(12):3698-3711. https://doi.org/10.1007/s00464-015-4140-y
Boone BA, Zenati M, Hogg ME, et al. Assessment of quality outcomes for robotic pancreaticoduodenectomy: identification of the learning curve. JAMA Surg. 2015;150(5):416-422. https://doi.org/10.1001/jamasurg.2015.17
Adam MA, Choudhury K, Dinan MA, et al. Minimally invasive versus open pancreaticoduodenectomy for cancer: practice patterns and short-term outcomes among 7061 patients. Ann Surg. 2015;262(2):372-377. https://doi.org/10.1097/SLA.0000000000001055
Nussbaum DP, Adam MA, Youngwirth LM, et al. Minimally invasive pancreaticoduodenectomy does not improve use or time to initiation of adjuvant chemotherapy for patients with pancreatic adenocarcinoma. Ann Surg Oncol. 2016;23(3):1026-1033. https://doi.org/10.1245/s10434-015-4937-x
van Hilst J, de Rooij T, Bosscha K, et al. Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial. Lancet Gastroenterol Hepatol. 2019;4(3):199-207. https://doi.org/10.1016/S2468-1253(19)30004-4
Zhang H, Feng Y, Zhao J, et al. Total laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy (TJDBPS01): study protocol for a multicentre, randomised controlled clinical trial. BMJ Open. 2020;10(2):1-9. https://doi.org/10.1136/bmjopen-2019-033490
Palanivelu C, Senthilnathan P, Sabnis SC, et al. Randomized clinical trial of laparoscopic versus open pancreatoduodenectomy for periampullary tumours. Br J Surg. 2017;104(11):1443-1450. https://doi.org/10.1002/bjs.10662
Poves I, Burdío F, Morató O, et al. Comparison of perioperative outcomes between laparoscopic and open approach for pancreatoduodenectomy: the PADULAP randomized controlled trial. Ann Surg. 2018;268(5):731-739. https://doi.org/10.1097/SLA.0000000000002893
Nassour I, Wang SC, Porembka MR, et al. Robotic versus laparoscopic pancreaticoduodenectomy: a NSQIP analysis. J Gastrointest Surg. 2017;21(11):1784-1792. https://doi.org/10.1007/s11605-017-3543-6. Epub 2017 Aug 17. PMID: 28819886; PMCID: PMC5789456.
Napoli N, Kauffmann EF, Menonna F, et al. Robotic versus open pancreatoduodenectomy: a propensity score-matched analysis based on factors predictive of postoperative pancreatic fistula. Surg Endosc. 2018;32(3):1234-1247. https://doi.org/10.1007/s00464-017-5798-0
Cai J, Ramanathan R, Zenati MS, et al. Robotic pancreaticoduodenectomy is associated with decreased clinically relevant pancreatic fistulas: a propensity-matched analysis. J Gastrointest Surg. 2019 Jul 2. https://doi.org/10.1007/s11605-019-04274-1
Zureikat AH, Postlewait LM, Liu Y, et al. A multi-institutional comparison of perioperative outcomes of robotic and open pancreaticoduodenectomy. Ann Surg. 2016;264(4):640-649. https://doi.org/10.1097/SLA.0000000000001869
Kantor O, Pitt HA, Talamonti MS, et al. Minimally invasive pancreatoduodenectomy: is the incidence of clinically relevant postoperative pancreatic fistula comparable to that after open pancreatoduodenectomy? Surgery. 2018;163(3):587-593. https://doi.org/10.1016/j.surg.2017.12.001
McMillan MT, Zureikat AH, Hogg ME, et al. A propensity score-matched analysis of robotic vs open pancreatoduodenectomy on incidence of pancreatic fistula. JAMA Surg. 2017;152(4):327-335. https://doi.org/10.1001/jamasurg.2016.4755