Impact of conversion at the time of minimally invasive pancreaticoduodenectomy: a review of the national cancer database

Presenter: Daisy Sanchez MD | Memorial Healthcare System Background: Current literature presents limited data regarding outcomes following conversion at the time of minimally invasive pancreaticoduodenectomy (MI-PD). We aim to compare perioperative, oncologic and survival between patients who required from MI-PD open (CO-PD) with underwent pancreatectomy (O-PD) on a national level. Methods: The National Cancer Database was queried for pancreaticoduodenectomy. Patients were stratified into three groups: (MI-PD), converted (CO-PD), (O-PD). Multivariable modeling applied O-PD while adjusting patient tumor characteristics. Results: Among 17,570 identified, 2,191 (12.5%) (2.3% robotic 10.2% laparoscopic), 734 (4.2%) CO-PD, 14,645 (83.4%) O-PD. Baseline demographics characteristics similar among cohorts. Robotic (R-PD) resulted in significantly higher lymph node yield (n = 23.2 ± 12.2) even when requiring (R-CO, n 22.4 13.2) compared 17.6, 9.5) (p 0.00). Margin positivity CO-PD (robotic (R-CO) 36.6%, laparoscopic (L-CO) 25.4%) (R-PD 22.7%, L-PD 21.3%) (22.6%) group 0.017). Length stay (days) shortest (L-PD 10.4 8.6, R-PD 10.6 8.8) R-CO (10.7 6.4), L-CO (11.2 9) (11.5 8.9) 0.000). 30-day readmission, mortality 90-day groups. After characteristics, both (OR 1.40; p 0.000) 1.24; P 0.030) associated an increased likelihood long-term survival. Conclusion: Minimally-invasive approach is not poorer short-term outcomes. Despite noted increase positive margin rate, still