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Comparing Minimally Invasive and Open Pancreaticoduodenectomy for the Treatment of Pancreatic Cancer: a Win Ratio Analysis

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Introduction

Despite its rising adoption, the use of minimally invasive (MIS) pancreaticoduodenectomy (PD) in the treatment of pancreatic cancer remains controversial. We sought to compare MIS and open PD for pancreatic cancer resection in terms of short-term, long-term, and oncologic outcomes using the win ratio, a novel statistical approach.

Methods

Patients undergoing PD for pancreatic adenocarcinoma 2010–2016 were identified from the National Cancer Database (NCDB). Patients were paired based on age, sex, race, tumor size, Charlson-Deyo score, and receipt of neoadjuvant chemotherapy. The win ratio was calculated based on 30-day and 3-year mortality, receipt of adjuvant chemotherapy, surgical margin status, examination of at least 11 lymph nodes, extended length of stay, and 30-day readmission.

Results

Among 18,936 patients, median age was 67 (IQR: 60–74); most patients had stage II disease at diagnosis (n = 16,530, 87.3%) and tumor size ≥ 2 cm (n = 15,880, 83.9%). The majority of patients underwent open PD (n = 16,409, 86.7%) versus MIS PD (n = 2527, 13.3%). For every matched patient-patient pair, the odds of the patient undergoing MIS PD “winning” were 1.14 (95%CI 1.13–1.15) higher versus open PD. The benefits of MIS PD were most pronounced among patients with tumor size < 2 cm (WR 1.21, 95%CI 1.13–1.30 versus ≥ 2 cm, WR 1.13, 95%CI 1.12–1.14) and patients who received neoadjuvant chemotherapy prior to resection (WR 1.28, 95%CI 1.23–1.32 versus no neoadjuvant chemotherapy, WR 1.13, 95%CI 1.11–1.14).

Conclusions

MIS PD may be preferable to open PD based on a hierarchical composite outcome that considered short-term, long-term, and oncologic outcomes.

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Authors and Affiliations

  1. Department of Surgery, The Ohio State University, Wexner Medical Center and James Cancer Hospital and Solove Research Institute, 395 W. 12th Ave., Suite 670, Columbus, OH, USA

    Eliza W. Beal, Djhenne Dalmacy, Alessandro Paro, J. Madison Hyer, Jordan Cloyd, Mary Dillhoff, Aslam Ejaz & Timothy M. Pawlik

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  1. Eliza W. Beal
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Contributions

EWB, DD, AP, JMH, JC, MD, AE, and TMP conceptualized the study design. DD, EWB, and AP performed the data analysis and drafted the work. EWB, DD, AP, JMH, JC, MD, AE, and TMP revised the work critically for important intellectual content. All authors approved the final version to be submitted and agree to be accountable for all aspects of the work.

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Correspondence to Timothy M. Pawlik.

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Beal, E.W., Dalmacy, D., Paro, A. et al. Comparing Minimally Invasive and Open Pancreaticoduodenectomy for the Treatment of Pancreatic Cancer: a Win Ratio Analysis. J Gastrointest Surg 26, 1697–1704 (2022). https://doi.org/10.1007/s11605-022-05380-3

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