Comparing Open and Laparoscopic Left-Sided Pancreatic Resection at a National Level: An IDEAL IV Study on Implementation, Population-Adjusted Resection Rate, and Achieved Ideal Outcomes

Abstract

Background: Left-sided pancreatectomies are increasingly done by minimally invasive surgery (MIS), but variation persists in clinical practice. The implementation of MIS at a population level may identify areas for improvement. The aim of this study was to investigate the implementation of minimally invasive left-sided pancreatic resections at a national level, using population-adjusted resection rates and impact on a composite ideal outcome.

Study design: All open and laparoscopic left-sided pancreatectomies as recorded in a national quality register, as a nationwide IDEAL stage IV cohort study from 2016 to 2023. Population-adjusted resection rates over time were calculated. Rates of ideal outcome were calculated and risk was expressed as odds ratio with 95% CI.

Results: The study period included 817 left-sided pancreatectomies, of which 519 (63.5%) were by minimally invasive access. The temporal age- and sex-adjusted resection rates for open and laparoscopic procedures were stable, but with regional variation in MIS. MIS was associated with shorter hospital stays and increased discharge-to-home rates. Patients selected for laparoscopy were younger, had better performance status and American Society for Anesthesiology risk score, and achieved higher ideal outcomes. In multivariable analysis, achieving an ideal outcome was associated with MIS in nonobese patients with good performance status in the recent time period and with health region.

Conclusions: A temporal stability in resection rates and access type within regions demonstrated significant differences in the use of MIS. Although MIS was associated with the selection of younger, nonobese patients and lower rates of malignant lesions, it was also associated with 2-fold higher rates of ideal outcomes.