Introduction: The purpose of the study is to compare perioperative and survival outcomes in elderly patients undergoing laparoscopic pancreaticoduodenectomy (LPD) to those undergoing open pancreaticoduodenectomy (OPD).
Methods: Patients aged ≥ 75 years with pancreatic adenocarcinoma undergoing LPD or OPD were identified from the NCDB (2010-2013). Baseline characteristics and perioperative outcomes were compared using a χ and Student's t test. The Kaplan-Meier method was used to generate survival curves, and differences were tested using a log-rank test. A multivariate cox proportional hazard model was applied to estimate the hazard ratio (HR) of LPD on overall survival (OS).
Results: We identified 1768 patients aged ≥ 75 years who underwent LPD (n = 248, 14.0%) or OPD (n = 1520, 86.0%). The majority of patients in the LPD group had their surgery at facilities performing less than 5 LPDs per year (n = 165, 66.5%). 90-day mortality was significantly lower in the LPD compared to the OPD (7.2 vs. 12.2%, p = 0.049). The laparoscopic conversion rate was 30% (n = 74) and was associated with higher readmission rates (13.5 vs. 8.1%), 30-day mortality (8.0 vs. 3.8%), and 90-day mortality (10.4 vs. 6.0%), but these did not reach statistical significance. Median OS was significantly longer in the LPD group (19.8 vs. 15.6 months, p = 0.022). After adjusting for patient and tumor-related characteristics, there was a trend towards improved survival in the LPD group (HR 0.85, 95% CI 0.69-1.03).
Conclusion: The vast majority of the NCDB participating facilities perform less than 5 LPD cases per year, which was associated with an increased risk of perioperative mortality. Overall 90-day mortality was significantly lower in the LPD group and there was a trend towards improved OS in the LPD group compared to the OPD group after adjusting for patient and tumor-related characteristics. Studies with increased sample size and longer follow-up are needed before definitive conclusions can be made.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1007/s00464-017-5915-0 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
An exploratory study on the differential diagnostic indicators between adult systemic EBV-positive T-cell lymphoproliferative disorders and angioimmunoblastic T-cell lymphoma with multiple EBV infections.
Infect Agent Cancer
January 2025
Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Background: The differential diagnosis between adult systemic EBV-positive T-cell lymphoproliferative disorders (EBV T-LPD) and angioimmunoblastic T-cell lymphoma (AITL) with multiple EBV infections is difficult, and distinguishing between the two has become a diagnostic challenge for pathologists. Given that the clinical treatment plans are different, an accurate diagnosis is a prerequisite to ensure effective treatment, therefore, it is extremely necessary and meaningful to find effective pathological indicators for distinguishing between two diseases.
Methods: We present a retrospective study comparing 7 cases of adult EBV T-LPD and 16 cases of AITL with multiple EBV infections diagnosed at our institution from 2017 to 2022.
Integration of CD200, CD43 and ROR1 in Multiparameter Flow Cytometry (MFC) Routine Panels for the Differential Diagnosis of B-cell lymphoproliferative Disorders (B-LPDs).
Mediterr J Hematol Infect Dis
January 2025
Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy.
Background: Clonal mature B-cell lymphoproliferative disorders (B-LPDs) are a heterogeneous group of neoplasia characterized by the proliferation of mature B lymphocytes in the peripheral blood, bone marrow and/or lymphoid tissues. B-LPDs classification into different subtypes and their diagnosis is based on a multiparametric approach. However, accurate diagnosis may be challenging, especially in cases of ambiguous interpretation.
View Article and Find Full Text PDFPretreatment red blood cell distribution width as a predictive marker for postoperative complications after laparoscopic pancreatoduodenectomy.
World J Gastrointest Oncol
January 2025
Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China.
Background: Red blood cell distribution width (RDW) is associated with the development and progression of various diseases.
Aim: To explore the association between pretreatment RDW and short-term outcomes after laparoscopic pancreatoduodenectomy (LPD).
Methods: A total of 804 consecutive patients who underwent LPD at our hospital between March 2017 and November 2021 were retrospectively analyzed.
Impact of Modified Blumgart Anastomosis on Pancreatic Fistula and Pancreaticojejunostomy Time During Laparoscopic Pancreaticoduodenectomy: Single-Center Experience.
J Clin Med
December 2024
Department of Surgery, Hallym University Sacred Heart Hospital, Anyang 14068, Republic of Korea.
/: The aim of this study is to evaluate the impact of modified Blumgart anastomosis methods during pancreaticojejunostomy (PJ) on the incidence of clinically relevant postoperative pancreatic fistula (POPF) after laparoscopic pancreaticoduodenectomy (LPD). : This is a retrospective cohort study analyzing data of patients who underwent LPD from 2018 to 2022. The primary endpoint was the incidence of grade B and C POPF based on the International Study Group on Pancreatic Fistula criteria and PJ anastomosis time.
View Article and Find Full Text PDFOncological resection and perioperative outcomes of robotic, laparoscopic and open pancreatoduodenectomy for ampullary adenocarcinoma: a propensity score matched international multicenter cohort study.
HPB (Oxford)
December 2024
Department of Surgery, Fondazione Poliambulanza, Brescia, Italy. Electronic address:
Background: Ampullary adenocarcinoma (AAC) typically presents at an early stage due to biliary obstruction and therefore might be specifically suitable for minimally invasive pancreatoduodenectomy (MIPD). However, studies assessing MIPD specifically for AAC, including the robotic and laparoscopic approach, are limited. The aim of this study is to compare short- and long-term oncological resection and perioperative outcomes of robotic (RPD), laparoscopic (LPD) and open pancreatoduodenectomy (OPD) performed specifically for AAC.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!