Discrepancies in survival after conversion to open in minimally invasive pancreatoduodenectomy

Anthony M. Villano, Karen Ruth, Jason Castellanos, Jeffrey M. Farma, Sanjay S. Reddy

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


BACKGROUND: The extent by which conversion to open (CTO) during minimally invasive procedures for pancreatic cancer impact survival outcomes is not fully understood.

METHODS: The 2010-2017 National Cancer Database identified 12,424 non-metastatic patients who underwent pancreatoduodenectomy for ductal adenocarcinoma. Patients were stratified into three cohorts: open (OPD), completed MIPD (cMIPD), and CTO. Subgroups were dichotomized by hospital MIPD volume.

RESULTS: Across the study period, 80.6% of patients underwent OPD, 19.4% MIPD, and 24% were CTO. Median overall survival was worse after CTO (21.8 months) than for OPD (23.6 months) or cMIPD (25.2 months) (p < 0.001). Although this effect persisted for <10 MIPD/year, CTO did comparably to OPD at hospitals performing ≥10MIPD/year (CTO = 26.8 months, OPD = 27.9 months; p = 0.128). Ninety-day mortality after CTO was worse at ≤ 10 MIPD/year hospitals (9.3% vs. 2.6%).

CONCLUSIONS: Short and long-term survival is impacted by CTO after MIPD, especially at lower surgical volumes, stressing careful adoption while ascending the learning curve.

Original languageEnglish
Pages (from-to)728-734
Number of pages7
JournalAmerican Journal of Surgery
Issue number4
StatePublished - Apr 2023


  • Databases, Factual
  • Hospitals
  • Humans
  • Laparoscopy
  • Minimally Invasive Surgical Procedures/methods
  • Neoplasms/surgery
  • Pancreas/surgery
  • Pancreatic Neoplasms/pathology
  • Pancreaticoduodenectomy/methods
  • Postoperative Complications/epidemiology
  • Retrospective Studies
  • Conversion
  • Survival
  • Outcomes
  • Minimally invasive
  • Pancreas
  • Cancer


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