Comparable short-term outcomes after laparoscopic vs. open surgery for pancreatic cancer
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Key takeaways:
- Laparoscopic pancreaticoduodenectomy had longer operating times, but patients lost less blood vs. open surgery.
- Postoperative complications and 90-day mortality were similar between groups.
Laparoscopic pancreaticoduodenectomy had similar short-term outcomes compared with open surgery among patients with pancreatic ductal adenocarcinoma, according to study results published in JAMA Surgery.
“Pancreaticoduodenectomy (PD) was first developed for lesions of the head of the pancreas and has evolved over the last 100 years,” Min Wang, MD, from Huazhong University of Science and Technology, and colleagues wrote. “With the development of minimally invasive surgery, laparoscopic PD (LPD), once known as the Mount Everest of pancreatic surgery, has undergone unprecedented development in recent years.”
Researchers continued: “Although various reports have shown that LPD is safe, there is a paucity of studies with sufficient numbers of patients that would allow laparoscopic surgery in PDAC to be clinically accepted.”
In an investigator-initiated, multicenter, parallel-group, open-label study, Wang and colleagues compared short- and long-term outcomes among 200 patients (mean age, 61.3 years; 39% women) with pancreatic ductal adenocarcinoma (PDAC) who underwent either LPD (n = 100) or open PD (n = 100) between September 2019 and March 2022.
Although the primary endpoint of 5-year overall survival is pending, researchers reported secondary short-term outcomes of operative findings, complications, mortality and oncological results.
Results showed patients in the LPD group had longer median operative times (330 min vs. 297 min) and experienced less blood loss (median 145 mL vs. 200 mL) compared with those in the open PD group. Two patients in the LPD group died within 90 days of the procedure vs. none in the open PD group.
The overall postoperative morbidity rate was 46% vs. 54%, respectively, with similar comprehensive complication index scores (0 vs. 8.7) between groups. Researchers also reported no differences in rates of severe complications of Clavien-Dindo grade III or greater (17% vs. 23%) or median postoperative length of stay, which was 14 days for both groups.
Further, rates of reoperation (3% vs. 2%) and 90-day readmission (0% vs. 2%) were not significantly different.
“The findings in this study indicate that, in selected patients treated by skilled surgeons, LPD for PDAC provided similar short-term safety outcomes as [open PD],” Wang and colleagues concluded. “The in-hospital recovery after laparoscopic surgery was noninferior to that after open surgery. Long-term follow-up to assess survival is necessary to ascertain the oncological safety of laparoscopic resection in patients with PDAC.”
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