• Sjors Klompmaker, Desley van Zoggel, Ammara A Watkins, Mariam F Eskander, Jennifer F Tseng, Marc G Besselink, and A James Moser.
• *The Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA †Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA ‡Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands §Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
• Ann. Surg. 2016 Sep 6.

ObjectiveTo assess current nationwide case selection factors for minimally invasive distal pancreatectomy (MIDP) and identify actual risk factors for adverse outcomes compared with open distal pancreatectomy (ODP).BackgroundPatient selection criteria that predict outcomes after MIDP remain unknown. As a result, widespread adoption of this surgical technique may have been delayed and its potential benefits possibly under-exploited.MethodsRetrospective cohort study of elective ODP and MIDP performed at 106 centers in 2014, using the pancreas-targeted American College of Surgeons' National Quality Improvement Program (ACS-NSQIP) database. Exclusion criteria were neoadjuvant treatment or pancreatitis as only diagnosis. Primary outcome includes a composite major morbidity metric, reflecting adverse events including mortality and reoperation. Multivariable modeling was used to detect current selection factors and to identify actual risk factors of composite major morbidity.ResultsA total of 928 patients underwent ODP (n = 472) or MIDP (n = 456) using a laparoscopic or robot-assisted approach, 24% for pancreatic ductal adenocarcinoma (PDAC). Current selection factors for MIDP were benign disease (odds ratio: OR: 1.56, CI: 1.10-2.21) and body mass index (BMI) 30-40 (OR: 1.41, CI: 1.04-1.91). Current selection factors for ODP were PDAC (OR: 0.45, CI: 0.31-0.64), benign tumor size >5 centimeters (OR: 0.40, CI: 0.23-0.67), and multivisceral procedures (OR: 0.39, CI: 0.26-0.59). Risk factors for composite major morbidity did not differ between ODP and MIDP. A trend was observed between MIDP and a lower risk of composite major morbidity compared with ODP (OR: 0.43, CI: 0.17-1.07).ConclusionsCurrent selection factors for ODP or MIDP (benign disease, tumor size, and BMI) do not mitigate the risk of major morbidity. We found no evidence that MIDP should be avoided based on tumor etiology or size, BMI, or patient physical status.

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