Comparison of laparoscopic versus open pancreaticoduodenectomy in patients with resectable pancreatic ductal adenocarcinoma: A propensity score-matching analysis of long-term survival |
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| Affiliation: | 1. Department of Pathology, Incheon St. Mary''s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea;2. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;3. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;4. Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;1. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;2. Department of Statistics, Korea University, Seoul, Republic of Korea;3. Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea;4. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;5. Department of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;6. Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;1. Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China;2. Emergency Department, Third Xiangya Hospital, Central South University, Changsha, China;1. Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India;2. Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India;3. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India;4. Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India |
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| Abstract: | BackgroundMany studies have shown the short-term feasibility and effectiveness of laparoscopic pancreaticoduodenectomy (LPD) are comparable to open pancreaticoduodenectomy (OPD). However, the long-term oncological safety of LPD in patients with pancreatic ductal adenocarcinoma (PDAC) remains to be elucidated.MethodsPatients who underwent LPD or OPD between July 2014 and July 2018 at our institution were identified, and those with resectable, pathologically diagnosed PDAC were analyzed. The primary outcome was overall survival (OS). Propensity score-matching (PSM) analysis was performed to balance the baseline characteristics between groups. Cox proportional hazards model was constructed to determine independent predictors of OS.ResultsThe original cohort consisted of 64 LPD and 80 OPD cases, in which, the laparoscopic group had a significantly longer median OS (25 vs. 17 months; P = 0.034). A higher proportion of laparoscopic patients received adjuvant therapy (51.6 vs. 32.5%; P = 0.021). PSM analysis identified 47 patient pairs. No significant differences in OS (21 vs. 17 months; P = 0.220) or adjuvant therapy utilization (53.2 vs. 38.3%; P = 0.248) were observed between the matched groups. Multivariate Cox analyses showed that receiving adjuvant therapy (HR = 0.44; 95% CI, 0.28–0.68), histopathological differentiation (poor vs. moderate-to-well differentiation; HR = 1.93; 95% CI, 1.26–2.95), and sex (female vs. male, HR = 0.47, 95% CI, 0.30–0.75) were independent predictors of OS.ConclusionsLPD can be comparable to OPD in terms of long-term safety for patients with resectable pancreatic ductal adenocarcinoma when performed in a high-volume center. |
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| Keywords: | Pancreatic cancer Pancreaticoduodenectomy Laparoscopic Oncological outcome |
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