Minimally invasive surgery (MIS) is often advocated for patients with obesity as a safer alternative. MIS pancreaticoduodenectomy is becoming increasingly popular, however without consistent benefits in all cohorts, including the elderly and low-volume centres. This study aims to compare the post-operative outcomes of MIS versus open pancreaticoduodenectomy in a growing population, namely, obese patients. Patients with severe obesity or a body mass index (BMI) ≥ 35 kg/m 2 undergoing a pancreaticoduodenectomy from the National Surgical Quality Improvement Program database were included. Association of MIS with 30-day serious complications and mortality was analyzed using multivariable logistic regression and propensity matching analysis. In this study, 1859 patients were included, with 1785 undergoing open and 74 undergoing MIS pancreatoduodenectomy. Multivariable analysis did not show an association between a MIS approach and 30-day serious complications OR 1.11, p = 0.760 or mortality OR 2.54, p = 0.176. Results were similar with the propensity matched analysis which, showed that MIS had longer operative durations 86.6 minutes, p < 0.001), but with similar rates of serious complications, Comprehensive Complication Index (CCI) scores, and mortality. For patients with severe obesity, this study demonstrates that MIS pancreatoduodenectomy does not significantly decrease the morbidity or mortality within the confinements of our population size. Future studies should assess which patient cohorts are more likely to benefit from MIS and the impact of the learning curve. Synopsis : There is equivocal data regarding the safety profile of minimally invasive versus open pancreaticoduodenectomy and we sought to investigate the utility of this procedure in patients with severe obesity. We included over 1800 patients using the NSQIP database who underwent a pancreaticoduodenectomy with a body mass index ≥ 35 kg/m 2 and found that a minimally invasive approach was not associated with increased 30-day morbidity or mortality on multivariable or propensity matched analysis.
Gugala et al. (Fri,) studied this question.