A Comparative Analysis of Open Versus Minimally Invasive Pancreatoduodenectomies

Background and Objectives: Pancreatoduodenectomy (PD) has been associated with significant morbidity and mortality. To reduce morbidity, minimally invasive pancreatoduodenectomies (MIPD) have become more prevalent. We aimed to compare short-term survival and complications for open (OPD) versus MIPD and to assess the relationship between operative approach and operative time on outcomes. Methods: Patients undergoing PD between 2017 and 2020 were identified within the National Surgical Quality Improvement Program (NSQIP). The primary outcome was operative time, and the secondary outcomes were death at 30 days, reoperation, readmission, and NSQIP-identified 30-day postoperative complications. A multivariable logistic regression was performed. Results: A total of 14 977 PDs were performed from 2017 to 2020. MIPD increased from less than 8% of pancreatoduodenectomies performed in 2017 to over 10% of PD by 2020. Of the MIPD cohort, 62% were robotic, and 38% were laparoscopic, with robotic surgery becoming most prevalent by the end of the study period. MIPD was associated with significantly longer operative times than OPD (p < 0.01). MIPD was associated with decreased odds of postoperative bleeding and surgical site infection (p < 0.01), but higher odds of death at 30 days. Conclusions: MIPD has been shown to have improved postoperative outcomes compared to OPD but is associated with longer operative times, which can be associated with increased complications.