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Minimally-invasive versus open pancreatoduodenectomies with vascular resection: A 1:1 propensity-matched comparison study
BACKGROUND: Minimally invasive pancreatic pancreatoduodenectomy (MIPD) is increasingly adopted worldwide and its potential advantages include reduced hospital stay and decrease pain. However, evidence supporting the role of MIPD for tumours requiring vascular reconstruction remains limited and requi...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9306132/ https://www.ncbi.nlm.nih.gov/pubmed/35708385 http://dx.doi.org/10.4103/jmas.jmas_201_21 |
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author | Yang, Edwin Chong, Yvette Wang, Zhongkai Koh, Ye-Xin Lim, Kai-Inn Goh, Brian K. P. |
author_facet | Yang, Edwin Chong, Yvette Wang, Zhongkai Koh, Ye-Xin Lim, Kai-Inn Goh, Brian K. P. |
author_sort | Yang, Edwin |
collection | PubMed |
description | BACKGROUND: Minimally invasive pancreatic pancreatoduodenectomy (MIPD) is increasingly adopted worldwide and its potential advantages include reduced hospital stay and decrease pain. However, evidence supporting the role of MIPD for tumours requiring vascular reconstruction remains limited and requires further evaluation. This study aims to investigate the safety and efficacy of MIPD with vascular resection (MIPDV) by performing a 1:1 propensity-score matched (PSM) comparison with open pancreatoduodenectomy with vascular resection (OPDV) based on a single surgeon's experience. METHODS: This is a retrospective review of 41 patients who underwent PDV between 2011 and 2020 by a single surgeon. After PSM, the comparison was made between 13 MIPDV and 13 OPDV. RESULTS: Thirty-six patients underwent venous reconstruction (VR) only and 5 underwent arterial reconstruction of which 4 had concomitant VR. The types of VR included 22 wedge resections with primary repair, 8 segmental resections with primary anastomosis and 11 requiring interposition grafts. Post-operative pancreatic fistula (POPF) occurred in 3 (7.3%) patients. Major complications (>Grade 2) occurred in 16 (39%) patients, of which 7 were due to delayed gastric emptying requiring nasojejunal tube placement. There was 1 (2.4%) 30-day mortality (OPDV). Of the 13 MIPDV, there were 3 (23.1%) open conversions. PSM comparison demonstrated that MIPDV was associated with longer median operative time (720 min vs. 485 min (P = 0.018). There was no statistically significant difference in other key perioperative outcomes such as intra-operative blood loss, overall morbidity, major morbidity rate, POPF and length of stay. CONCLUSION: Our initial experience with the adoption MIPDV has demonstrated it to be safe with comparable outcomes to OPDV despite the longer operation time. |
format | Online Article Text |
id | pubmed-9306132 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-93061322022-07-23 Minimally-invasive versus open pancreatoduodenectomies with vascular resection: A 1:1 propensity-matched comparison study Yang, Edwin Chong, Yvette Wang, Zhongkai Koh, Ye-Xin Lim, Kai-Inn Goh, Brian K. P. J Minim Access Surg Original Article BACKGROUND: Minimally invasive pancreatic pancreatoduodenectomy (MIPD) is increasingly adopted worldwide and its potential advantages include reduced hospital stay and decrease pain. However, evidence supporting the role of MIPD for tumours requiring vascular reconstruction remains limited and requires further evaluation. This study aims to investigate the safety and efficacy of MIPD with vascular resection (MIPDV) by performing a 1:1 propensity-score matched (PSM) comparison with open pancreatoduodenectomy with vascular resection (OPDV) based on a single surgeon's experience. METHODS: This is a retrospective review of 41 patients who underwent PDV between 2011 and 2020 by a single surgeon. After PSM, the comparison was made between 13 MIPDV and 13 OPDV. RESULTS: Thirty-six patients underwent venous reconstruction (VR) only and 5 underwent arterial reconstruction of which 4 had concomitant VR. The types of VR included 22 wedge resections with primary repair, 8 segmental resections with primary anastomosis and 11 requiring interposition grafts. Post-operative pancreatic fistula (POPF) occurred in 3 (7.3%) patients. Major complications (>Grade 2) occurred in 16 (39%) patients, of which 7 were due to delayed gastric emptying requiring nasojejunal tube placement. There was 1 (2.4%) 30-day mortality (OPDV). Of the 13 MIPDV, there were 3 (23.1%) open conversions. PSM comparison demonstrated that MIPDV was associated with longer median operative time (720 min vs. 485 min (P = 0.018). There was no statistically significant difference in other key perioperative outcomes such as intra-operative blood loss, overall morbidity, major morbidity rate, POPF and length of stay. CONCLUSION: Our initial experience with the adoption MIPDV has demonstrated it to be safe with comparable outcomes to OPDV despite the longer operation time. Wolters Kluwer - Medknow 2022 2022-02-11 /pmc/articles/PMC9306132/ /pubmed/35708385 http://dx.doi.org/10.4103/jmas.jmas_201_21 Text en Copyright: © 2022 Journal of Minimal Access Surgery https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Yang, Edwin Chong, Yvette Wang, Zhongkai Koh, Ye-Xin Lim, Kai-Inn Goh, Brian K. P. Minimally-invasive versus open pancreatoduodenectomies with vascular resection: A 1:1 propensity-matched comparison study |
title | Minimally-invasive versus open pancreatoduodenectomies with vascular resection: A 1:1 propensity-matched comparison study |
title_full | Minimally-invasive versus open pancreatoduodenectomies with vascular resection: A 1:1 propensity-matched comparison study |
title_fullStr | Minimally-invasive versus open pancreatoduodenectomies with vascular resection: A 1:1 propensity-matched comparison study |
title_full_unstemmed | Minimally-invasive versus open pancreatoduodenectomies with vascular resection: A 1:1 propensity-matched comparison study |
title_short | Minimally-invasive versus open pancreatoduodenectomies with vascular resection: A 1:1 propensity-matched comparison study |
title_sort | minimally-invasive versus open pancreatoduodenectomies with vascular resection: a 1:1 propensity-matched comparison study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9306132/ https://www.ncbi.nlm.nih.gov/pubmed/35708385 http://dx.doi.org/10.4103/jmas.jmas_201_21 |
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