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Minimally Invasive Distal Pancreatectomy Techniques: A Contemporary Analysis Exploring Trends, Similarities, and Differences to Open Surgery

SIMPLE SUMMARY: While the adoption of minimally invasive pancreatectomy had lagged, it has become more mainstream in recent years. Hand-assisted laparoscopic technique, an adjunct to laparoscopic surgery may offer the benefits of a total laparoscopic approach while mitigating the technical challenge...

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Autores principales: Romero-Hernandez, Fernanda, Mohamedaly, Sarah, Miller, Phoebe, Rodriguez, Natalie, Calthorpe, Lucia, Conroy, Patricia C., Ganjouei, Amir Ashraf, Hirose, Kenzo, Maker, Ajay V., Nakakura, Eric, Corvera, Carlos, Kirkwood, Kimberly S., Alseidi, Adnan, Adam, Mohamed A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9688336/
https://www.ncbi.nlm.nih.gov/pubmed/36428717
http://dx.doi.org/10.3390/cancers14225625
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author Romero-Hernandez, Fernanda
Mohamedaly, Sarah
Miller, Phoebe
Rodriguez, Natalie
Calthorpe, Lucia
Conroy, Patricia C.
Ganjouei, Amir Ashraf
Hirose, Kenzo
Maker, Ajay V.
Nakakura, Eric
Corvera, Carlos
Kirkwood, Kimberly S.
Alseidi, Adnan
Adam, Mohamed A.
author_facet Romero-Hernandez, Fernanda
Mohamedaly, Sarah
Miller, Phoebe
Rodriguez, Natalie
Calthorpe, Lucia
Conroy, Patricia C.
Ganjouei, Amir Ashraf
Hirose, Kenzo
Maker, Ajay V.
Nakakura, Eric
Corvera, Carlos
Kirkwood, Kimberly S.
Alseidi, Adnan
Adam, Mohamed A.
author_sort Romero-Hernandez, Fernanda
collection PubMed
description SIMPLE SUMMARY: While the adoption of minimally invasive pancreatectomy had lagged, it has become more mainstream in recent years. Hand-assisted laparoscopic technique, an adjunct to laparoscopic surgery may offer the benefits of a total laparoscopic approach while mitigating the technical challenges associated with it. Previous studies investigating the different approaches in distal pancreatectomy have predominately focused on comparing outcomes between total laparoscopic (LDP) vs. open distal pancreatectomy (ODP); however, limited research has focused on outcomes associated with the hand-assisted distal pancreatectomy (HALDP) approach. This study demonstrates that compared to ODP, LDP was associated with improved surgical site infection rates. There was no difference in surgical site infection rates between ODP and HALDP. LDP was associated with longer operative times (+10 min only). Surgeon comfort and experience should decide the operative approach, but it is important to discuss the differences between these approaches with patients. ABSTRACT: Limited contemporary data has compared similarities and differences between total laparoscopic (LDP), hand-assisted (HALDP), and open distal pancreatectomy (ODP). This study aimed to examine similarities and differences in outcomes between these three approaches in a contemporary cohort. Methods: Patients undergoing elective LDP, HALDP, and ODP in the NSQIP dataset (2014–2019) were included. Descriptive statistics and multivariate regression analyses were employed to compare postoperative outcomes. Results: Among 5636 patients, 33.9% underwent LDP, 13.1% HALDP, and 52.9% ODP. Compared with the LDP approach, surgical site infections were more frequent in HALDP and ODP approaches (1.2% vs. 2.6% vs. 2.8%, respectively, p < 0.01). After adjustment, the LDP approach was associated with a significantly lower likelihood of surgical site infection (OR 0.25, p = 0.03) when compared to ODP. There was no difference in the likelihood of surgical site infection when HALDP was compared to ODP (OR 0.59, p = 0.40). Unadjusted operative times were similar between approaches (LDP = 192 min, HALDP = 193 min, ODP = 191 min, p = 0.59). After adjustment, the LDP approach had a longer operative time (+10.3 min, p = 0.04) compared to ODP. There was no difference in the adjusted operative time between HALDP and ODP approaches (+5.4 min, p = 0.80). Conclusions: Compared to ODP, LDP was associated with improved surgical site infection rates and slightly longer operative times. There was no difference in surgical site infection rates between ODP and HALDP. Surgeon comfort and experience should decide the operative approach, but it is important to discuss the differences between these approaches with patients.
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spelling pubmed-96883362022-11-25 Minimally Invasive Distal Pancreatectomy Techniques: A Contemporary Analysis Exploring Trends, Similarities, and Differences to Open Surgery Romero-Hernandez, Fernanda Mohamedaly, Sarah Miller, Phoebe Rodriguez, Natalie Calthorpe, Lucia Conroy, Patricia C. Ganjouei, Amir Ashraf Hirose, Kenzo Maker, Ajay V. Nakakura, Eric Corvera, Carlos Kirkwood, Kimberly S. Alseidi, Adnan Adam, Mohamed A. Cancers (Basel) Article SIMPLE SUMMARY: While the adoption of minimally invasive pancreatectomy had lagged, it has become more mainstream in recent years. Hand-assisted laparoscopic technique, an adjunct to laparoscopic surgery may offer the benefits of a total laparoscopic approach while mitigating the technical challenges associated with it. Previous studies investigating the different approaches in distal pancreatectomy have predominately focused on comparing outcomes between total laparoscopic (LDP) vs. open distal pancreatectomy (ODP); however, limited research has focused on outcomes associated with the hand-assisted distal pancreatectomy (HALDP) approach. This study demonstrates that compared to ODP, LDP was associated with improved surgical site infection rates. There was no difference in surgical site infection rates between ODP and HALDP. LDP was associated with longer operative times (+10 min only). Surgeon comfort and experience should decide the operative approach, but it is important to discuss the differences between these approaches with patients. ABSTRACT: Limited contemporary data has compared similarities and differences between total laparoscopic (LDP), hand-assisted (HALDP), and open distal pancreatectomy (ODP). This study aimed to examine similarities and differences in outcomes between these three approaches in a contemporary cohort. Methods: Patients undergoing elective LDP, HALDP, and ODP in the NSQIP dataset (2014–2019) were included. Descriptive statistics and multivariate regression analyses were employed to compare postoperative outcomes. Results: Among 5636 patients, 33.9% underwent LDP, 13.1% HALDP, and 52.9% ODP. Compared with the LDP approach, surgical site infections were more frequent in HALDP and ODP approaches (1.2% vs. 2.6% vs. 2.8%, respectively, p < 0.01). After adjustment, the LDP approach was associated with a significantly lower likelihood of surgical site infection (OR 0.25, p = 0.03) when compared to ODP. There was no difference in the likelihood of surgical site infection when HALDP was compared to ODP (OR 0.59, p = 0.40). Unadjusted operative times were similar between approaches (LDP = 192 min, HALDP = 193 min, ODP = 191 min, p = 0.59). After adjustment, the LDP approach had a longer operative time (+10.3 min, p = 0.04) compared to ODP. There was no difference in the adjusted operative time between HALDP and ODP approaches (+5.4 min, p = 0.80). Conclusions: Compared to ODP, LDP was associated with improved surgical site infection rates and slightly longer operative times. There was no difference in surgical site infection rates between ODP and HALDP. Surgeon comfort and experience should decide the operative approach, but it is important to discuss the differences between these approaches with patients. MDPI 2022-11-16 /pmc/articles/PMC9688336/ /pubmed/36428717 http://dx.doi.org/10.3390/cancers14225625 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Romero-Hernandez, Fernanda
Mohamedaly, Sarah
Miller, Phoebe
Rodriguez, Natalie
Calthorpe, Lucia
Conroy, Patricia C.
Ganjouei, Amir Ashraf
Hirose, Kenzo
Maker, Ajay V.
Nakakura, Eric
Corvera, Carlos
Kirkwood, Kimberly S.
Alseidi, Adnan
Adam, Mohamed A.
Minimally Invasive Distal Pancreatectomy Techniques: A Contemporary Analysis Exploring Trends, Similarities, and Differences to Open Surgery
title Minimally Invasive Distal Pancreatectomy Techniques: A Contemporary Analysis Exploring Trends, Similarities, and Differences to Open Surgery
title_full Minimally Invasive Distal Pancreatectomy Techniques: A Contemporary Analysis Exploring Trends, Similarities, and Differences to Open Surgery
title_fullStr Minimally Invasive Distal Pancreatectomy Techniques: A Contemporary Analysis Exploring Trends, Similarities, and Differences to Open Surgery
title_full_unstemmed Minimally Invasive Distal Pancreatectomy Techniques: A Contemporary Analysis Exploring Trends, Similarities, and Differences to Open Surgery
title_short Minimally Invasive Distal Pancreatectomy Techniques: A Contemporary Analysis Exploring Trends, Similarities, and Differences to Open Surgery
title_sort minimally invasive distal pancreatectomy techniques: a contemporary analysis exploring trends, similarities, and differences to open surgery
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9688336/
https://www.ncbi.nlm.nih.gov/pubmed/36428717
http://dx.doi.org/10.3390/cancers14225625
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