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HPB (Oxford). 2019 Nov;21(11):1585-1591. doi: 10.1016/j.hpb.2019.03.375. Epub 2019 May 7.

Does surgical approach affect outcomes of enucleation for benign and low-grade pancreatic tumors? An ACS-NSQIP evaluation.

Author information

1
The Pancreas and Liver Institute at Beth Israel Deaconess Medical Center, Boston, MA, USA.
2
The Pancreas and Liver Institute at Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, University of Amsterdam, Netherlands.
3
The Pancreas and Liver Institute at Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: ajmoser@bidmc.harvard.edu.

Abstract

BACKGROUND:

Enucleation of low-grade pancreatic tumors achieves oncological outcomes equivalent to resection but conserves parenchyma. Given strict selection criteria, we hypothesized that minimally-invasive (MI) enucleation is associated with decreased composite major morbidity (CMM) compared to open.

METHODS:

Pancreas-targeted ACS NSQIP (2014 -2016) was queried for enucleation (CPT code: 48120) and analyzed by intended surgical approach regardless of conversion. The primary outcome was CMM, a validated 30-day composite metric of adverse events.

RESULTS:

Enucleation was performed using an open (n = 71; 62.3%) or MI (n = 43; 37.7%) approach with 7 conversions (16.2%). Both cohorts had interchangeable baseline characteristics. No selection factors governing MI were identified. MI-enucleation reduced median length of stay (4 vs. 5 days; p = 0.003), whereas rates of CMM after open (24; 34%) and MIenucleation (12; 28%) were equivalent (p = 0.541). Multivariable analysis demonstrated an association between CMM and prolonged operative time (OR 2.7, 95% CI 1.14 -6.74), female sex (OR 0.38, 95% CI 0.16 -0.94), and ASA score <3 (OR 0.39, 95% CI 0.16 -0.96) but not surgical approach.

CONCLUSION:

MI-enucleation was not associated with reduced 30-day CMM compared to open, whereas prolonged operating time and unmodifiable patient factors were correlated with adverse outcomes.

PMID:
31076257
DOI:
10.1016/j.hpb.2019.03.375

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