Analysis of Outcomes of Open, Robotic and Laparoscopic Pancreaticoduodenectomy Using NSQIP

Objective Several large volume centers have published positive outcomes with laparoscopic and robotic pancreaticoduodenectomy. The purpose of this study was to compare postoperative outcomes between open, laparoscopic and robotic pancreaticoduodenectomies using ACS National Quality Improvement Program. Methods We performed a review of 2014-2015 NSQIP targeted data for patients undergoing pancreatoduodenectomies for pancreatic cancer. Patient who underwent conversion from robotic or laparoscopic approach to open were excluded. Outcome measures were 30-day postoperative complications, and mortality. Results 11,218 patients who underwent pancreaticoduodenectomies were evaluated. Majority were performed in open fashion (n=8654) were open, followed by laparoscopic (n=1508), and robotic approach (n=596). Compared to open approach, laparoscopic PD had lower rates of SSI, and pneumonia rates; however longer operative time (354 vs. 482 min; p<0.001). We found higher rates of 30-day mortality in patients undergoing robotic or laparoscopic pancreaticoduodenectomy when compared to the open group. Conclusion Smaller incisions did not predict reduced mortality or morbidity benefit in patients undergoing pancreaticoduodenectomy.