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Improved oncologic outcomes for minimally invasive left pancreatectomy: Propensity‐score matched analysis of the National Cancer Database
Author(s) -
Watson Michael D.,
BaimasGeorge Maria R.,
Thompson Kyle J.,
Iannitti David A.,
Ocuin Lee M.,
Baker Erin H.,
Martinie John B.,
Vrochides Dionisios
Publication year - 2020
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.26147
Subject(s) - medicine , propensity score matching , perioperative , subgroup analysis , pancreatectomy , pancreatic cancer , cohort , surgery , cancer , database , confidence interval , resection , computer science
Background and objectives Minimally invasive (MIS) left pancreatectomy (LP) is increasingly used to treat pancreatic adenocarcinoma (PDAC). Despite improved short‐term outcomes, no studies have demonstrated long‐term benefits over open resection. Methods The National Cancer Database was queried between 2010 and 2016 for patients with PDAC, grouped by surgical approach (MIS vs open). Demographics, comorbidities, clinical staging, and pathologic staging were used for propensity‐score matching. Perioperative, short‐term oncologic, and survival outcomes were compared. Results After matching, both cohorts included 805 patients. There were no differences in baseline characteristics, staging, or preoperative therapy between cohorts. The MIS cohort had a shorter length of stay (6.8 ± 5.5 vs 8.5 ± 7.3 days; P < .0001) with the trend toward improved time to chemotherapy (53.9 ± 26.1 vs 57.9 ± 29.9 days; P = .0511) and margin‐positive resection rate (15.3% vs 18.9%; P = .0605). Lymph node retrieval and receipt of chemotherapy were similar. The MIS cohort had higher median overall survival (28.0 vs 22.1 months; P = .0067). Subgroup analysis demonstrated the highest survival for robotic compared with laparoscopic and open LP (41.9 vs 26.6 vs 22.1 months; P < .0001). Conclusions This study demonstrates the safety of MIS LP and favorable long‐term oncologic outcomes. The improved survival after MIS LP warrants further study with prospective, randomized trials.