Effects of Minimally Invasive Versus Open Pancreatoduodenectomy on Short-Term Surgical Outcomes and Postoperative Nutritional and Immunological Statuses: A Single-Institution Propensity Score-Matched Study
Objective:. To evaluate the feasibility and clinical impact of minimally invasive pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) on postoperative nutritional and immunological indices. Background:. The surgical advantages of MIPD over OPD are controversial, and the postoperativ...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Health
2024-09-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000487 |
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| author | Shinsei Yumoto, MD Hiromitsu Hayashi, MD, PhD Kosuke Mima, MD, PhD Daisuke Ogawa, MD Rumi Itoyama, MD, PhD Yuki Kitano, MD, PhD Shigeki Nakagawa, MD, PhD Hirohisa Okabe, MD, PhD Hideo Baba, MD, PhD |
| author_facet | Shinsei Yumoto, MD Hiromitsu Hayashi, MD, PhD Kosuke Mima, MD, PhD Daisuke Ogawa, MD Rumi Itoyama, MD, PhD Yuki Kitano, MD, PhD Shigeki Nakagawa, MD, PhD Hirohisa Okabe, MD, PhD Hideo Baba, MD, PhD |
| author_sort | Shinsei Yumoto, MD |
| collection | DOAJ |
| description | Objective:. To evaluate the feasibility and clinical impact of minimally invasive pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) on postoperative nutritional and immunological indices.
Background:. The surgical advantages of MIPD over OPD are controversial, and the postoperative nutritional and immunological statuses are unknown.
Methods:. In total, 306 patients who underwent MIPD (n = 120) or OPD (n = 186) for periampullary tumors from April 2016 to February 2024 were analyzed. Surgical outcomes and postoperative nutritional and immunological indices (albumin, prognostic nutritional index [PNI], neutrophil-to-lymphocyte ratio [NLR], and platelet-to-lymphocyte ratio [PLR]) were examined by 1:1 propensity score matching (PSM) with well-matched background characteristics.
Results:. PSM resulted in 2 balanced groups of 99 patients each. Compared with OPD, MIPD was significantly associated with less estimated blood loss (P < 0.0001), fewer intraoperative blood transfusions (P = 0.001), longer operative time, shorter postoperative hospital stay (P < 0.0001), fewer postoperative complications (P = 0.001) (especially clinically relevant postoperative pancreatic fistula [P = 0.018]), and a higher rate of textbook outcome achievement (70.7% vs 48.5%, P = 0.001). The number of dissected lymph nodes and the R0 resection rate did not differ between the 2 groups. In elective cases with textbook outcome achievement, the change rates of albumin, PNI, NLR, and PLR from before to after surgery were equivalent in both groups.
Conclusions:. MIPD has several surgical advantages (excluding a prolonged operative time), and it enhances the achievement of textbook outcomes over OPD. However, the postoperative nutritional and immunological statuses are equivalent for both procedures. |
| format | Article |
| id | doaj-art-e1c785e7467742b083e674b55c5bea92 |
| institution | Kabale University |
| issn | 2691-3593 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj-art-e1c785e7467742b083e674b55c5bea922025-01-24T09:18:49ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932024-09-0153e48710.1097/AS9.0000000000000487202409000-00035Effects of Minimally Invasive Versus Open Pancreatoduodenectomy on Short-Term Surgical Outcomes and Postoperative Nutritional and Immunological Statuses: A Single-Institution Propensity Score-Matched StudyShinsei Yumoto, MD0Hiromitsu Hayashi, MD, PhD1Kosuke Mima, MD, PhD2Daisuke Ogawa, MD3Rumi Itoyama, MD, PhD4Yuki Kitano, MD, PhD5Shigeki Nakagawa, MD, PhD6Hirohisa Okabe, MD, PhD7Hideo Baba, MD, PhD8* From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.* From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.* From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.* From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.* From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.* From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.* From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.* From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.* From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.Objective:. To evaluate the feasibility and clinical impact of minimally invasive pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) on postoperative nutritional and immunological indices. Background:. The surgical advantages of MIPD over OPD are controversial, and the postoperative nutritional and immunological statuses are unknown. Methods:. In total, 306 patients who underwent MIPD (n = 120) or OPD (n = 186) for periampullary tumors from April 2016 to February 2024 were analyzed. Surgical outcomes and postoperative nutritional and immunological indices (albumin, prognostic nutritional index [PNI], neutrophil-to-lymphocyte ratio [NLR], and platelet-to-lymphocyte ratio [PLR]) were examined by 1:1 propensity score matching (PSM) with well-matched background characteristics. Results:. PSM resulted in 2 balanced groups of 99 patients each. Compared with OPD, MIPD was significantly associated with less estimated blood loss (P < 0.0001), fewer intraoperative blood transfusions (P = 0.001), longer operative time, shorter postoperative hospital stay (P < 0.0001), fewer postoperative complications (P = 0.001) (especially clinically relevant postoperative pancreatic fistula [P = 0.018]), and a higher rate of textbook outcome achievement (70.7% vs 48.5%, P = 0.001). The number of dissected lymph nodes and the R0 resection rate did not differ between the 2 groups. In elective cases with textbook outcome achievement, the change rates of albumin, PNI, NLR, and PLR from before to after surgery were equivalent in both groups. Conclusions:. MIPD has several surgical advantages (excluding a prolonged operative time), and it enhances the achievement of textbook outcomes over OPD. However, the postoperative nutritional and immunological statuses are equivalent for both procedures.http://journals.lww.com/10.1097/AS9.0000000000000487 |
| spellingShingle | Shinsei Yumoto, MD Hiromitsu Hayashi, MD, PhD Kosuke Mima, MD, PhD Daisuke Ogawa, MD Rumi Itoyama, MD, PhD Yuki Kitano, MD, PhD Shigeki Nakagawa, MD, PhD Hirohisa Okabe, MD, PhD Hideo Baba, MD, PhD Effects of Minimally Invasive Versus Open Pancreatoduodenectomy on Short-Term Surgical Outcomes and Postoperative Nutritional and Immunological Statuses: A Single-Institution Propensity Score-Matched Study Annals of Surgery Open |
| title | Effects of Minimally Invasive Versus Open Pancreatoduodenectomy on Short-Term Surgical Outcomes and Postoperative Nutritional and Immunological Statuses: A Single-Institution Propensity Score-Matched Study |
| title_full | Effects of Minimally Invasive Versus Open Pancreatoduodenectomy on Short-Term Surgical Outcomes and Postoperative Nutritional and Immunological Statuses: A Single-Institution Propensity Score-Matched Study |
| title_fullStr | Effects of Minimally Invasive Versus Open Pancreatoduodenectomy on Short-Term Surgical Outcomes and Postoperative Nutritional and Immunological Statuses: A Single-Institution Propensity Score-Matched Study |
| title_full_unstemmed | Effects of Minimally Invasive Versus Open Pancreatoduodenectomy on Short-Term Surgical Outcomes and Postoperative Nutritional and Immunological Statuses: A Single-Institution Propensity Score-Matched Study |
| title_short | Effects of Minimally Invasive Versus Open Pancreatoduodenectomy on Short-Term Surgical Outcomes and Postoperative Nutritional and Immunological Statuses: A Single-Institution Propensity Score-Matched Study |
| title_sort | effects of minimally invasive versus open pancreatoduodenectomy on short term surgical outcomes and postoperative nutritional and immunological statuses a single institution propensity score matched study |
| url | http://journals.lww.com/10.1097/AS9.0000000000000487 |
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