Impact of Minimally Invasive Approach on the Attainment of a Textbook Oncologic Outcome Following Pancreaticoduodenectomy for Pancreatic Cancer

Introduction: Textbook oncologic outcome (TOO) is a composite outcome measure of short-term quality metrics following an oncologic operation. This study examined whether utilizing a minimally invasive approach increases the likelihood of attaining TOO. Methods: The 2010 – 2016 National Cancer Database was queried for patients with pancreatic adenocarcinoma who underwent PD. Patients were stratified into two groups: open pancreaticoduodenectomy (O – PD) and minimally invasive pancreaticoduodenectomy (MI – PD). Multivariable modeling was applied to compare outcomes while adjusting for patient/tumor characteristics. TOO was defined as having met five metrics previously established. Results: Of 13,863 patients identified, 87.4% underwent O – PD and 12.6% MI – PD. MI – PD patients were significantly more likely to have traveled farther for their care and to have been treated in an academic/research program. The MI – PD group had a significantly higher average number lymph node yield (p = 0.000) and were more likely to have received adjuvant chemotherapy (p = 0.018). A higher proportion of MI – PD patients met the following: adequate LAD, no prolonged LOS and no 30 – day readmission. 35.6 % of the MI – PD group achieved TOO compared to 28% of O – PD (p = 0.000). The MI – PD TOO group had significantly higher median OS compared to the O – PD TOO group. Adjusted regression models revealed MI – PD is significantly more likely to have no prolonged LOS, adequate LAD, and to have attained TOO. Conclusion: MI – PD significantly increases the likelihood of TOO. When achieved, MI – PD TOO is associated with a higher median OS.