Patients with pancreatic ductal adenocarcinoma whose pancreaticoduodenectomy is converted from minimally invasive surgery to open surgery (CTO) as a result of complications may do better in centers that perform less invasive pancreatic cancer surgery annually. I have. According to a new study published by Villano et al. American Journal of Surgery.
Pancreatic ductal adenocarcinoma is the seventh leading cause of cancer mortality worldwide and is the most common type of pancreatic cancer. Treatment usually requires pancreatoduodenectomy, also called Whipple surgery. This is a complex operation that removes the head of the pancreas, gallbladder, bile ducts, part of the small intestine, and sometimes part of the stomach.
To improve patient outcomes, clinicians are moving toward using minimally invasive laparoscopic or robotic surgical methods when performing these procedures. However, a previous study found that if the surgical team was forced to stop minimally invasive surgery and transition to CTO surgery because of complications, those patients were more likely to have postoperative pain than if they had open surgery from the beginning. have been shown to have poor outcomes.
“Impact of [moving to CTO] Surgery is highest in inexperienced, low-volume centers, and going to hospitals that perform these procedures on a high volume significantly mitigates these downstream effects,” emphasized the lead study author. Anthony Villano, M.D., Clinical Instructor of Surgical Oncology, Department of General Surgery, Fox Chase Cancer Center. “Results tend to be best in places with more experience with this procedure,” he added.
Research methods and results
Using eight years of data from the National Cancer Database, Dr. Villano and colleagues examined survival in patients with nonmetastatic pancreatic ductal adenocarcinoma after pancreatoduodenectomy.
The researchers categorized patients by type of surgery (open surgery, minimally invasive surgery that was successful, minimally invasive surgery that transitioned to CTO surgery), and those that transitioned to CTO surgery had shorter morbidity than other patients. We found the rate and mortality to be poor. two other groups. In addition, patients who underwent CTO surgery had worse long-term survival compared with those who had successful initial minimally invasive or open surgery.
Researchers then compared patient outcomes based on the hospital where they were treated. Hospitals that performed 10 or more minimally invasive pancreaticoduodenectomies each year were considered large facilities, and fewer were considered low-scale facilities.
Short- and long-term mortality continued to be significantly worse than patients who underwent successful minimally invasive surgery when their CTO surgery was performed at a center with a low patient population. However, in centers with high patient volumes, this effect was mitigated and survival rates were similar in all three of her patient groups.
The researchers emphasized that the next step in improving patient outcomes is to identify factors that contribute to the disparity in survival in patients whose surgery has been converted to CTO surgery.
“What is the high volume center’s ‘secret sauce’? What do they do differently from the low volume center? Experience is one factor, but many others I think there are factors.
The researchers concluded that their findings revealed the importance of safe adoption strategies for surgeons learning how to successfully perform minimally invasive pancreaticoduodenectomy.
Disclosure: For full disclosure of the study authors, please see: americanjournalofsurgery.com.
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