Nationwide Evaluation of Patient Selection for Minimally Invasive Distal Pancreatectomy Using American College of Surgeons' National Quality Improvement Program

Sjors Klompmaker, Desley van Zoggel, Ammara A. Watkins, Mariam F. Eskander, Jennifer F. Tseng, Marc G. Besselink, A. James Moser*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objective: To 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).

Background: Patient 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.

Methods: Retrospective 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.

Results: A 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) 3040 (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).

Conclusions: Current 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.

Original languageEnglish
Pages (from-to)1055-1061
Number of pages7
JournalAnnals of Surgery
Issue number6
Publication statusPublished - Dec 2017


  • benign pancreatic disease
  • comparative effectiveness
  • country-level database
  • distal pancreatectomy
  • laparoscopic pancreatectomy
  • large database
  • minimally invasive distal pancreatectomy
  • morbidity
  • mortality
  • nationwide analysis
  • open distal pancreatectomy
  • pancreas
  • pancreatectomy
  • pancreatic cancer
  • pancreatic surgery
  • patient outcomes
  • robot-assisted pancreatectomy
  • selection factors
  • surgical outcomes analysis


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