Effect of Operative Time on Outcomes of Minimally Invasive Versus Open Pancreatoduodenectomy

Michael D Williams; Anuradha R Bhama; Samer Naffouje; Sivesh K Kamarajah; Adan Z Becerra; Yanyu Zhang; Sam G Pappas; Fadi S Dahdaleh

doi:10.1007/s11605-022-05504-9

Effect of Operative Time on Outcomes of Minimally Invasive Versus Open Pancreatoduodenectomy

J Gastrointest Surg. 2023 Jan;27(1):93-104. doi: 10.1007/s11605-022-05504-9. Epub 2022 Nov 10.

Authors

Michael D Williams^{1

2}, Anuradha R Bhama³, Samer Naffouje⁴, Sivesh K Kamarajah⁵, Adan Z Becerra¹, Yanyu Zhang⁶, Sam G Pappas¹, Fadi S Dahdaleh⁷

Affiliations

¹ Department of Surgery, Rush University Medical Center, Chicago, IL, USA.
² Department of Surgery, John H. Stroger Hospital of Cook County, Chicago, IL, USA.
³ Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA.
⁴ Department of Surgical Oncology, H. Lee Moffit Cancer Center, Tampa, FL, USA.
⁵ Department of Surgery, University Hospitals Birmingham NHS Trust, Birmingham, UK.
⁶ Research Informatics Core, Rush University Medical Center, Chicago, IL, USA.
⁷ Department of Surgical Oncology, Edward-Elmhurst Health, 120 Spalding Drive, Suite 205, Naperville, IL, 60540, USA. fadi.dahdaleh@eehealth.org.

PMID: 36357742
DOI: 10.1007/s11605-022-05504-9

Abstract

Objective: To evaluate how operative time interacts with outcomes among different approaches to pancreaticoduodenectomy (PD). Minimally invasive PDs (MIPD), which include laparoscopic (LPD) and robotic (RPD) approaches, are increasingly performed in the USA. MIPD are generally associated with longer operative times (OT) compared to open PD (OPD). Increased OT is associated with inferior outcomes for OPD; however, the effect of OT on MIPD is not well understood.

Methods: National Surgical Quality Improvement Program (NSQIP)-targeted pancreatectomy dataset was utilized (2014-2019). Propensity score matching, logistic regression, and mixed effect modeling were performed to determine the effect of OT on outcomes following PD. OTs were stratified by quartiles for each approach, and outcomes were subsequently compared.

Results: Among 23,988 PDs, 22,185 were OPD and 1803 MIPD. Increased OT was associated with greater overall morbidity in all approaches. When comparing OT quartiles, MIPD was consistently associated with improved overall morbidity compared to OPD in matched cohorts. However, for upper quartiles, prolonged OT in MIPD was associated with significantly increased reoperation rates and mortality. The effect of OT on overall morbidity and other outcomes was comparable among LPD and RPD.

Conclusions: In this study, increased OT was associated with incremental increases in overall morbidity after PD, irrespective of approach. While MIPD was associated with improved overall morbidity compared to OPD when stratified by OT quartile, higher mortality rates were observed with prolonged OT only with MIPD. Those data suggest that MIPD is a safe alternative to OPD when OT is optimized. NSQIP was used to compare the effect of operative time (OT) on outcomes following pancreaticoduodenectomy (PD), stratified by approach. Increased OT was associated with inferior outcomes following open, laparoscopic, and robotic PD. Surgeons should attempt to optimize OT, regardless of the approach to PD.

Keywords: Minimally invasive pancreaticoduodenectomy; Operative time; Outcomes.

MeSH terms

Humans
Laparoscopy* / adverse effects
Operative Time
Pancreatic Neoplasms* / surgery
Pancreaticoduodenectomy / adverse effects
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Postoperative Complications / surgery
Reoperation
Retrospective Studies
Robotic Surgical Procedures* / adverse effects
Robotics*