Table 4.
Intent to treat analysis: Clinicopathologic factors, surgical variables, and outcomes associated with surgical approach
| Variable | Lap/Robotic |
Hand-Assist |
Open |
Lap/Rob vs Hand |
Open vs Hand |
|---|---|---|---|---|---|
| n = 383 (%) | n = 50 (%) | n = 573 (%) | P value | P value | |
|
| |||||
| Baseline demographics | |||||
|
| |||||
| Age (years, mean ± std) | 59 ± 15 | 62 ± 13 | 62 ± 14 | 0.25 | 0.70 |
|
| |||||
| Male | 145 (38) | 26 (52) | 269 (47) | 0.08 | 0.59 |
|
| |||||
| ASA class | |||||
|
| |||||
| 1 | 12 (3) | 0 (0) | 4 (0.7) | 0.16 | 0.66 |
|
|
|||||
| 2 | 149 (39) | 16 (33) | 203 (35) | ||
|
|
|||||
| 3 | 210 (55) | 30 (61) | 347 (61) | ||
|
|
|||||
| 4 | 10 (3) | 3 (6) | 19 (3) | ||
|
|
|||||
| 5 | 0 (0) | 0 (0) | 0 (0) | ||
|
|
|||||
| BMI (kg/m2, mean ± std) | 29 ± 13 | 30 ± 7 | 28 ± 6 | 0.51 | <0.01 |
|
| |||||
| Comorbidities | |||||
|
| |||||
| Diabetes | 72 (19) | 9 (18) | 122 (21) | 1.0 | 0.71 |
|
| |||||
| Congestive heart failure | 6 (2) | 3 (6) | 2 (0.3) | 0.08 | <0.01 |
|
| |||||
| Severe COPD | 3 (0.8) | 1 (2) | 7 (1) | 0.39 | 1.0 |
|
| |||||
| Chronic renal failure | 6 (20) | 6 (12) | 18 (3) | <0.01 | <0.01 |
|
| |||||
| Prior abdominal operations | 174 (46) | 29 (60) | 258 (46) | 0.09 | 0.07 |
|
| |||||
| Symptoms at presentation | |||||
|
| |||||
| Incidental/asymptomatic | 220 (58) | 30 (60) | 324 (57) | 0.53 | 0.23 |
|
|
|||||
| Pancreatitis | 48 (130 | 9 (18) | 54 (10) | ||
|
|
|||||
| Jaundice | 1 (0.3) | 0 (0) | 0 (0) | ||
|
|
|||||
| Pain (not pancreatitis) | 71 (19) | 5 (10) | 112 (20) | ||
|
|
|||||
| Early satiety | 2 (0.5) | 0 (0) | 4 (0.7) | ||
|
|
|||||
| Bowel obstruction | 0 (0) | 0 (0) | 4 (0.7) | ||
|
|
|||||
| Other | 36 (10) | 6 (12) | 72 (13) | ||
|
|
|||||
| Intra-operative outcomes | |||||
|
| |||||
| Length of surgery (minutes) | 191 ± 74 | 157 ± 64 | 157 ± 84 | <0.01 | 0.97 |
|
| |||||
| Operative blood loss (mL) | 208 ± 357 | 110 ± 153 | 323 ± 440 | <0.01 | <0.01 |
|
| |||||
| Any pRBC transfusion | 12 (3) | 0 (0) | 27 (5) | 0.37 | 0.23 |
|
| |||||
| Crystalloid (mL) | 2268 ± 1061 | 1632 ± 1023 | 1957 ± 1298 | <0.01 | 0.08 |
|
| |||||
| Colloid (mL) | 179 ± 345 | 109 ± 303 | 263 ± 443 | 0.13 | <0.01 |
|
| |||||
| Splenic resection | 358 (94) | 49 (98) | 565 (99) | 0.34 | 1.0 |
|
| |||||
| Size of tumor (cm) | 3.2 ± 2.0 | 3.7 ± 2.7 | 4.6 ± 3.6 | 0.25 | 0.11 |
|
| |||||
| Specimen length (cm) | 8.6 ± 3.8 | 9.1 ± 3.1 | 9.9 ± 3.4 | 0.36 | 0.12 |
|
| |||||
| Proximal parenchymal margin distance (mm) | 16.8 ± 14.9 | 18.0 ± 14.9 | 17.1 ± 15.1 | 0.66 | 0.74 |
|
| |||||
| Intraoperative drain placement | 171 (45) | 24 (48) | 189 (33) | 0.77 | 0.05 |
|
| |||||
| Lymph node resection | 343 (90) | 44 (88) | 556 (97) | 0.93 | <0.01 |
|
| |||||
| Lymph nodes (#) | 14.5 ± 9.9 | 15.3 ± 8.3 | 16.4 ± 9.7 | 0.59 | 0.45 |
|
| |||||
| Method of pancreatic transection | |||||
|
| |||||
| Scalpel | 38 (10) | 2 (4) | 274 (50) | 0.31 | <0.01 |
|
|
|||||
| Staple | 338 (89) | 48 (96) | 267 (49) | ||
|
|
|||||
| Energy | 3 (0.8) | 0 (0) | 9 (2) | ||
|
|
|||||
| Final resection statusa | |||||
|
| |||||
| R0 | 263 (93) | 38 (97) | 369 (82) | 0.15 | <0.01 |
|
|
|||||
| R1 | 18 (6) | 0 (0) | 78 (17) | ||
|
|
|||||
| R2 | 2 (1) | 1 (3) | 2 (0.4) | ||
|
| |||||
| Post-operative outcomes | |||||
|
| |||||
| Complication | 165 (43) | 22 (44) | 266 (46) | 0.90 | 0.84 |
|
| |||||
| Minor complication | 105 (64) | 15 (68) | 154 (58) | 0.69 | 0.47 |
|
|
|||||
| Major complication | 60 (36) | 7 (32) | 112 (42) | ||
|
|
|||||
| Drainage procedure | 37 (10) | 3 (6) | 74 (13) | 0.60 | 0.18 |
|
| |||||
| Reoperation | 9 (2) | 1 (2) | 17 (3) | 1.0 | 1.0 |
|
| |||||
| ICU admission | 14 (4) | 5 (10) | 34 (6) | 0.09 | 0.41 |
|
| |||||
| Length of stay (days, mean ± std) | 5.6 ± 2.9 | 5.1 ± 2.0 | 7.2 ± 5.4 | 0.26 | <0.01 |
|
| |||||
| Readmission | 67 (18) | 7 (14) | 114 (20) | 0.68 | 0.40 |
|
| |||||
| Thirty-day readmission | 57 (85) | 6 (86) | 101 (89) | 0.71 | 0.69 |
Bold indicates statistical significance.
a
For pre-malignant and malignant tumors only.