Impact of Conversion at the Time of Minimally Invasive Pancreaticoduodenectomy: A Review of the National Cancer Database

Introduction: Current literature presents limited outcomes following conversion at the time of minimally invasive pancreaticoduodenectomy (MI-PD). We aim to compare perioperative, oncologic outcomes and survival between patients who required conversion from MI-PD to open pancreaticoduodenectomy (CO-PD) with patients who underwent open pancreatectomy (O-PD) on a national level. Methods: The National Cancer Database was queried for patients. Patients were stratified into three groups: MI-PD, CO-PD, and O-PD. Multivariable modeling was applied to compare outcomes to O-PD while adjusting for patient/tumor characteristics. Results: Among 17,570 patients identified, 12.5% underwent MI-PD (2.3% robotic and 10.2% laparoscopic), 4.2% CO-PD, and 83.4% O-PD. Robotic pancreaticoduodenectomy (R-PD) resulted in a significantly higher lymph node yield (n = 23.2 ± 12.2) even when requiring conversion (R-CO, n = 22.4 ± 13.2) when compared to O-PD (n = 17.6, ± 9.5) (p = 0.00). Margin positivity was higher in the CO-PD compared to the MI-PD (R-PD 22.7%, L-PD 21.3%) and O-PD (22.6%) group (p = 0.017). Length of stay was shortest for MI-PD (L-PD 10.4 ± 8.6, R-PD 10.6 ± 8.8) and R-CO (10.7 ± 6.4). After adjusting for patient/tumor characteristics, both MI-PD (OR = 1.40; p = 0.000) and CO-PD (OR = 1.24; P = 0.030) were both significantly associated with an increased likelihood of long-term survival. Conclusion: Minimally-invasive pancreaticoduodenectomy with conversion to an open approach (CO-PD) is not associated with poorer short-term outcomes. Despite the noted increase positive margin rate, CO-PD was still associated with an increased likelihood of long-term survival when compared to O-PD.Tabled 1EP02D-174 Table 1. Outcomes of Patients Undergoing PancreaticoduodenectomyRobotic (%)Robotic-to-Open (%)Laparoscopic (%)Laparoscopic-to-Open (%)Open (%)P-ValueN (%)405 (2.3)71 (0.4)1,786 (10.2)663 (3.8)14,645 (83.4)-# Nodes, Mean ± SD23.2 ± 12.222.4 ± 13.219.1 ± 9.618.8 ± 9.717.6 ± 9.50.000Surgical Margins0.017 Negative313 (77.3)45 (63.4)1,385 (78.7)490 (74.6)11,237 (77.4) Positive92 (22.7)26 (36.6)375 (21.3)167 (25.4)3,273 (22.6)61 (15.1)19 (26.8)218 (12.3)117 (17.8)2,076 (14.3)LOS (Days) Mean ± SD10.6 ± 8.810.7 ± 6.410.4 ± 8.611.2 ± 9.011.5 ± 8.90.000 Open table in a new tab