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Minimally invasive surgical approaches offer earlier time to adjuvant chemotherapy but not improved survival in resected pancreatic cancer

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Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

MIS appears to offer comparable surgical oncologic benefit with improved LOS and shorter TTC. This effect, however, was not associated with improved survival.

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Funding

There are no funding sources to disclose in relation to this project.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, College of Medicine, The Pennsylvania State University, 500 University Drive, MC H070, Hershey, PA, 17033, USA

    Katelin A. Mirkin, Erin K. Greenleaf, Christopher S. Hollenbeak & Joyce Wong

  2. Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, USA

    Christopher S. Hollenbeak

Authors
  1. Katelin A. Mirkin
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  2. Erin K. Greenleaf
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  4. Joyce Wong
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Corresponding author

Correspondence to Joyce Wong.

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Disclaimer

The National Cancer Data Base (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Disclosure

Dr. Mirkin, Dr. Greenleaf, Dr. Hollenbeak, and Dr. Wong have no conflicts of interest or financial ties to disclose.

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Mirkin, K.A., Greenleaf, E.K., Hollenbeak, C.S. et al. Minimally invasive surgical approaches offer earlier time to adjuvant chemotherapy but not improved survival in resected pancreatic cancer. Surg Endosc 32, 2387–2396 (2018). https://doi.org/10.1007/s00464-017-5937-7

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  • DOI: https://doi.org/10.1007/s00464-017-5937-7

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