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- Title
Minimally invasive surgical approaches offer earlier time to adjuvant chemotherapy but not improved survival in resected pancreatic cancer.
- Authors
Mirkin, Katelin A.; Greenleaf, Erin K.; Hollenbeak, Christopher S.; Wong, Joyce
- Abstract
<bold>Background: </bold>Pancreatic surgery encompasses complex operations with significant potential morbidity. Greater experience in minimally invasive surgery (MIS) has allowed resections to be performed laparoscopically and robotically. This study evaluates the impact of surgical approach in resected pancreatic cancer.<bold>Methods: </bold>The National Cancer Data Base (2010-2012) was reviewed for patients with stages 1-3 resected pancreatic carcinoma. Open approaches were compared to MIS. A sub-analysis was then performed comparing robotic and laparoscopic approaches.<bold>Results: </bold>Of the 9047 patients evaluated, surgical approach was open in 7511 (83%), laparoscopic in 992 (11%), and robotic in 131 (1%). The laparoscopic and robotic conversion rate to open was 28% (n = 387) and 17% (n = 26), respectively. Compared to open, MIS was associated with more distal resections (13.5, 24.3%, respectively, p < 0.0001), shorter hospital length of stay (LOS) (11.3, 9.5 days, respectively, p < 0.0001), more margin-negative resections (75, 79%, p = 0.038), and quicker time to initiation of chemotherapy (TTC) (59.1, 56.3 days, respectively, p = 0.0316). There was no difference in number of lymph nodes obtained based on surgical approach (p = 0.5385). When stratified by type of resection (head, distal, or total), MIS offered significantly shorter LOS in all types. Multivariate analysis demonstrated no survival benefit for any MIS approach relative to open (all, p > 0.05). When adjusted for patient, disease, and treatment characteristics, TTC was not an independent prognostic factor (HR 1.09, p = 0.084).<bold>Conclusion: </bold>MIS appears to offer comparable surgical oncologic benefit with improved LOS and shorter TTC. This effect, however, was not associated with improved survival.
- Subjects
UNITED States; CANCER chemotherapy; PANCREATIC cancer; MINIMALLY invasive procedures; ADJUVANT treatment of cancer; LYMPH nodes; CANCER-related mortality; CANCER treatment; COMBINED modality therapy; DATABASES; LENGTH of stay in hospitals; LAPAROSCOPY; LONGITUDINAL method; MEDICAL care; PANCREATIC tumors; PATIENTS; SURGICAL robots; RETROSPECTIVE studies
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2018, Vol 32, Issue 5, p2387
- ISSN
1866-6817
- Publication type
journal article
- DOI
10.1007/s00464-017-5937-7