A decade of pancreatoduodenectomy outcomes for pancreatic adenocarcinoma: 2014-2023 analysis of the N SQIP pancreatectomy PUF database: A decade of pancreatoduodenectomy in NSQIP.

BACKGROUND: A decade of pancreas procedure-targeted NSQIP data can reveal trends in pancreatoduodenectomy (PD) at participating centers.

METHODS: The pancreatectomy PUFs 2014-2023 were queried for PDs performed for pancreatic adenocarcinoma (PDAC). Trends in neoadjuvant therapy (NAT), minimally invasive surgical (MIS) approach, vascular resection, positive margins, length of stay (LOS), unplanned conversion, post-operative pancreatic fistula (POPF), delayed gastric emptying (DGE), and 30-day mortality were evaluated across years with Chi-square and Mann-Kendall trend tests.

RESULTS: With 24,067 patients identified, NAT and MIS rates doubled 24.0%-50.0% and 6.3%-14.7% respectively, with the latter driven by robotic approach. Unplanned conversion rates remained stable at 24.0% with higher rates in laparoscopic vs. robotic (36.2% vs. 17.0%, p<0.001). Vascular resections increased 23.1%-26.5%. POPF rates improved 13.6%-10.2% (p=0.049). Thirty-day mortality and DGE remained stable at 1.8% and 15.0% respectively. Median LOS decreased from 9 to 7 days. Positive margin rate (available starting in 2021) increased 16.0%-18.1% (p=0.039). Laparoscopic had the highest positive margin rate, 25.4% vs. open 17.2% and robotic 15.4% (p=0.004).

CONCLUSION: Over the last decade, NAT, robotic MIS, and vascular resection increased while 30-day mortality and complication rates remained stable for PDAC PDs. Robotic had lower rates of unplanned conversion and positive margins compared to laparoscopic.