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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2021

01-12-2021 | Pancreatectomy | Pancreatic Tumors

Does a Laparoscopic Approach to Distal Pancreatectomy for Cancer Contribute to Optimal Adjuvant Chemotherapy Utilization?

Authors: Omid Salehi, MD, Eduardo A. Vega, MD, Onur C. Kutlu, MD, Sandeep Krishnan, MD, Danny Sleeman, MD, Nestor De La Cruz Munoz, MD, Sylvia V. Alarcon, MD, Vera Kazakova, MD, Olga Kozyreva, MD, Claudius Conrad, MD, PhD

Published in: Annals of Surgical Oncology | Issue 13/2021

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Abstract

Background

Although laparoscopic distal pancreatectomy (LDP) versus open approaches (ODP) for pancreatic adenocarcinoma (PDAC) is associated with reduced morbidity, its impact on optimal adjuvant chemotherapy (AC) utilization remains unclear. Furthermore, it is uncertain whether oncologic resection quality markers are equivalent between approaches.

Methods

The National Cancer Database (NCDB) was queried between 2010 and 2016 for PDAC patients undergoing DP. Effect of LDP vs ODP and institutional case volumes on margin status, hospital stay, 30-day and 90-day mortality, administration of and delay to AC, and 30-day unplanned readmission were analyzed using binary and linear logistic regression. Cox multivariable regression was used to correct for confounders.

Results

The search yielded 3411 patients; 996 (29.2%) had LDP and 2415 (70.8%) had ODP. ODP had higher odds of readmission [odds ratio (OR) 1.681, p = 0.01] and longer hospital stay [β 1.745, p = 0.004]. No difference was found for 30-day mortality [OR 1.689, p = 0.303], 90-day mortality [OR 1.936, p = 0.207], and overall survival [HR 1.231, p = 0.057]. The highest-volume centers had improved odds of AC [OR 1.275, p = 0.027] regardless of approach. LDP conferred lower margin positivity [OR 0.581, p = 0.005], increased AC use [3rd quartile: OR 1.844, p = 0.026; 4th quartile; OR 2.144, p = 0.045], and fewer AC delays [4th quartile: OR 0.786, p = 0.045] in higher-volume centers.

Conclusions

In selected patients, LDP offers an oncologically safe alternative to ODP for PDAC independent of institutional volume. However, additional oncologic benefit due to optimal AC utilization and lower positive margin rates in higher volume centers suggests that LDP by experienced teams can achieve best possible cancer outcomes.
Appendix
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Metadata
Title
Does a Laparoscopic Approach to Distal Pancreatectomy for Cancer Contribute to Optimal Adjuvant Chemotherapy Utilization?
Authors
Omid Salehi, MD
Eduardo A. Vega, MD
Onur C. Kutlu, MD
Sandeep Krishnan, MD
Danny Sleeman, MD
Nestor De La Cruz Munoz, MD
Sylvia V. Alarcon, MD
Vera Kazakova, MD
Olga Kozyreva, MD
Claudius Conrad, MD, PhD
Publication date
01-12-2021
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 13/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-021-10241-5

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