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Original Investigation |

Improved Perioperative Outcomes With Minimally Invasive Distal Pancreatectomy:  Results From a Population-Based Analysis

Hop S. Tran Cao, MD1,2; Nicole Lopez, MD2; David C. Chang, PhD2; Andrew M. Lowy, MD2; Michael Bouvet, MD2; Joel M. Baumgartner, MD2; Mark A. Talamini, MD2,3; Jason K. Sicklick, MD2
[+] Author Affiliations
1Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
2Department of Surgery, UC San Diego Health System, University of California, San Diego
3now with Department of Surgery, School of Medicine, State University of New York, Stony Brook
JAMA Surg. 2014;149(3):237-243. doi:10.1001/jamasurg.2013.3202.
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Importance  Interest in minimally invasive distal pancreatectomy (MIDP) has grown in recent years, but currently available data are limited. Greater insight into application patterns and outcomes may be gained from a national database inquiry.

Objectives  To study trends in the use of MIDP and compare the short-term outcomes of MIDP with those of open distal pancreatectomy.

Design, Setting, and Participants  Population-based retrospective cohort study evaluating perioperative outcomes and hospital charge measures for distal pancreatectomy, comparing the surgical approaches and adjusting for patient- and hospital-level factors, among patients undergoing elective distal pancreatectomy from 1998 to 2009 in the Nationwide Inpatient Sample in a 20% stratified sample of all US hospitals.

Main Outcomes and Measures  In-hospital mortality, rates of perioperative complications and splenectomy, total charges, and length of stay.

Results  A total of 8957 distal pancreatectomies were included in this analysis, of which 382 (4.3%) were MIDPs. On a national level, this projected to 42 320 open distal pancreatectomies and 1908 MIDPs. The proportion of distal pancreatectomies performed via minimally invasive approaches tripled between 1998 and 2009, from 2.4% to 7.3%. The groups were comparable for sex and comorbidity profiles, while patients who underwent MIDP were 1.5 years older. On multivariate analysis, MIDP was associated with lower rates of overall predischarge complications, including lower incidences of postoperative infections and bleeding complications, as well as a shorter length of stay by 1.22 days. There were no differences in rates of in-hospital mortality, concomitant splenectomy, or total charges.

Conclusions and Relevance  This population-based study of MIDP reveals that the application of this approach has tripled in practice and provides strong evidence that MIDP has evolved into a safe option in the treatment of benign and malignant pancreatic diseases.

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Figure.
Trends in Distal Pancreatectomy (DP) Performance From 1998 to 2009 in the Nationwide Inpatient Sample Database

While the numbers of open DP (ODP) and minimally invasive DP (MIDP) increased through the years, the performance of MIDP as a percentage of all DPs tripled during this period, from 2.4% to 7.3% of all DPs.

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