ASO Visual Abstract: Does a Laparoscopic Approach to Distal Pancreatectomy for Cancer Contribute to Optimal Adjuvant Chemotherapy Utilization?

Abstract

While laparoscopic distal pancreatectomy (LDP) versus open approaches (ODP) for pancreatic adenocarcinoma (PDAC) is associated with reduced morbidity, its impact on optimal adjuvant chemotherapy (AC) utilization and oncologic resection quality markers remains unclear. In our study, the National Cancer Database was queried between 2010 and 2016 for PDAC patients undergoing DP. The search yielded 3411 patients; 996 (29.2%) had LDP and 2415 (70.8%) had ODP. ODP had higher odds of readmission (OR 1.681, p = 0.01) and longer hospital stay (b 1.745, p = 0.004). No difference was found for 30-day mortality (OR 1.689, p = 0.303), 90-day mortality (OR 1.936, p = 0.207), and overall survival (HR 1.231, p = 0.057). The highest-volume centers had improved odds of AC (OR 1.275, p = 0.027) regardless of approach. LDP conferred lower margin positivity (OR 0.581, p = 0.005), increased AC use (third quartile: OR 1.844, p = 0.026; fourth quartile; OR 2.144, p = 0.045), and fewer AC delays (fourth quartile: OR 0.786, p = 0.045) in higher-volume centers. In selected patients, LDP offers an oncologically safe alternative to ODP for PDAC independent of institutional volume. However, additional oncologic benefit due to optimal AC utilization and lower positive margin rates in higher-volume centers suggests LDP by experienced teams can achieve best possible cancer outcomes.