In a Belgian single-institution retrospective study reported in JAMA Network Open, Topal et al found that minimally invasive pancreatic surgery (MIPS) was associated with better overall survival and disease-free survival vs open pancreatic surgery (OPS) for borderline resectable or resectable pancreatic ductal adenocarcinoma.
Study Details
The study was a propensity score–matched analysis among consecutive patients from a high-volume pancreatic cancer referral center (University Hospitals KU Leuven) that included 198 patients undergoing MIPS and 198 undergoing OPS between January 2010 and December 2019. Variables included in matching were TNM stage, tumor dimension, lymph node status, type of operation, simultaneous vascular resection, neoadjuvant chemotherapy, adjuvant chemotherapy, sex, age, and American Society of Anesthesiologists score. Additional corrections were made for year of surgery and type of adjuvant chemotherapy. All surgeries were performed by two pancreatic surgeons who were considered to have passed the ‘learning curve’—ie, both had performed at least 50 minimally invasive and 50 open procedures.
Key Findings
Median follow-up was 56.8 months (interquartile range = 32.7–84.2 months). Median overall survival was 30.7 months (95% confidence interval [CI] = 26.2–36.8 months) in the MIPS group vs 20.3 months (95% CI = 17.6–23.5 months) in the OPS group (hazard ratio [HR] = 0.70, 95% CI = 0.56–0.87, P = .002). Median disease-free survival was 14.8 months (95% CI = 11.8–17.0 months) in the MIPS group vs 10.7 months (95% CI = 9.0–12.1 months) in the OPS group (HR = 0.71, 95% CI = 0.57–0.89, P = .003).
MIPS was associated with improved overall survival (HR = 0.74, 95% CI = 0.57–0.96, P = .02) and disease-free survival (HR = 0.77, 95% CI = 0.59–0.99, P = .04) after additional correction for year of surgery. MIPS was associated with improved overall survival (HR = 0.71, 95% CI = 0.56–0.90, P = .005) and disease-free survival (HR = 0.72, 95% CI = 0.57–0.92, P = .009) after additional correction for type of adjuvant chemotherapy.
The investigators concluded, “In this study of 396 patients with borderline resectable and resectable pancreatic adenocarcinoma, MIPS was associated with better overall survival and disease-free survival than OPS. Centralization of MIPS should be stimulated, and pancreatic surgeons should be encouraged to pass the learning curve before implementing MIPS for pancreatic adenocarcinoma in daily clinical practice.”
Baki Topal, MD, PhD, of the Department of Visceral Surgery, University Hospitals KU Leuven, is the corresponding author for the JAMA Network Open article.
