Outcomes After Minimally-Invasive Versus Open Pancreatoduodenectomy

The following summary comes from the Annals of Surgery, a leading source of peer-reviewed surgical literature. Original article can be found here.

Outcomes after minimally-invasive versus open pancreatoduodenectomy.

Klompmaker, S., van Hilst, J., Wellner, U.F. et al.

Annals of Surgery, June 2018

The Dutch Pancreatic Cancer Group is a coalition of medical centers in the Netherlands that collaborate and share data to improve the overall quality of care of pancreatic disease. In 2018, this group lead a collaboration of 14 experienced medical centers in Europe to determine the outcomes in patients undergoing Whipple operations with either an open approach or a minimally invasive approach (i.e. laparoscopic or robotic). In this study, patients were matched by similarity to eliminate selection bias. A total of 1,458 patients were included (729 open and 729 minimally invasive).

This study found that there were no differences in the following:
– major postoperative complications
– postoperative mortality
– need for post-operative drain placements
– need for re-operations
– length of hospital stay

Significant differences were found in:
Postoperative pancreatic fistula (leaking fluid from the pancreas where it is reconnected to the small intestine). The authors suggest this may be due to the learning curve associated with this part of the operation. This complication was higher in the minimally invasive group, but no differences were found between laparoscopic vs. robotic.

Additionally, laparoscopic approaches were more likely to be converted to an open procedure as compared to robotic approaches.

In summary, minimally invasive approaches are appropriate choices for the right patients when performed at experienced medical centers. Proper patient selection is the product of multiple factors and should be discussed between the patient and their medical team. As more centers gain experience with minimally invasive surgery, these procedures will most likely become safer and available at more medical centers.

Summary written by Michael Wright

Department of Surgery, Johns Hopkins School of Medicine.