Introduction: While there is an increasing shift towards minimally invasive distal pancreatectomy (MIDP), little is known about how utilization of MIDP vs. open distal pancreatectomy (ODP) has evolved over time. We aimed to determine competing temporal trends in use and outcomes of MIDP (laparoscopic and robotic) over time and to determine if a threshold of effectiveness has been reached. Methods: Adults undergoing MIDP and ODP were identified from the National Cancer Database (2010–2021) and the National Surgical Quality Improvement Program database (2014–2022). Propensity score matching (PSM) was performed to address baseline differences between groups before comparing outcomes. Joinpoint regression analysis (JRA) was employed to assess adjusted trends in adoption and outcomes. We calculated Annual Percentage Change (APC) and Average Annual Percentage Change (AAPC) to quantify yearly adoption rates and their trends, respectively. Results: Among 21,966 patients in the NCDB cohort, 49.5% underwent MIDP, including 33.7% laparoscopic distal pancreatectomy (LDP) and 15.8% robotic distal pancreatectomy (RDP), while 50.5% underwent ODP. ODP declined from 74.1% of cases (2010) to 41.1% (2021), with an AAPC of −4.9%. MIDP increased significantly throughout the study from 25.9% of cases (2010) to 58.9% (2021), with an AAPC of 6.3%. Among MIDP subgroups, there was an initial increase in LDP until 2016, after which its rate of utilization stagnated with an AAPC of 0.7% (p> 0.05). In contrast, RDP demonstrated steady growth with an AAPC of about 15% (p< 0.05). A consistent and significant decline in clinically relevant postoperative pancreatic fistula rates occurred across all surgical approaches, with the most pronounced improvement observed in the robotic approach. MIDP approaches had significantly shorter hospital stays and lower mortality rates; however, RDP cases were associated with longer operative times compared to LDP and ODP. Conclusions: Over the past decade, the use of MIDP increased while ODP decreased. This increase was initially driven by greater use of LDP, which plateaued after 2016, and was further driven by the increased use of the robotic approach. Specifically, RDP demonstrated consistent growth, while LDP showed a decline around 2016. These findings highlight changing practice patterns, accompanied by improvements across all surgical approaches. This may provide insights for clinical training and resource allocation.
引言：尽管微创远端胰腺切除术的应用日益增多，但关于微创远端胰腺切除术与开腹远端胰腺切除术的临床应用随时间演变的情况尚不明确。本研究旨在分析微创远端胰腺切除术（腹腔镜与机器人辅助）应用趋势与疗效的时序变化，并评估其是否已达到有效阈值。方法：通过美国国家癌症数据库（2010-2021年）和美国外科手术质量改进计划数据库（2014-2022年）筛选接受微创远端胰腺切除术与开腹远端胰腺切除术的成年患者。在比较疗效前采用倾向评分匹配法平衡组间基线差异。运用Joinpoint回归模型分析技术应用与疗效的校正趋势，通过计算年度变化百分比和平均年度变化百分比分别量化年度应用率及其变化趋势。结果：在国家癌症数据库队列的21,966例患者中，49.5%接受微创远端胰腺切除术（其中腹腔镜远端胰腺切除术占33.7%，机器人辅助远端胰腺切除术占15.8%），50.5%接受开腹远端胰腺切除术。开腹远端胰腺切除术占比从2010年的74.1%下降至2021年的41.1%，平均年度变化百分比为-4.9%。微创远端胰腺切除术占比从2010年的25.9%显著上升至2021年的58.9%，平均年度变化百分比达6.3%。在微创亚组中，腹腔镜远端胰腺切除术在2016年前持续增长，此后应用率趋于平稳（平均年度变化百分比0.7%，p>0.05）；而机器人辅助远端胰腺切除术保持稳定增长（平均年度变化百分比约15%，p<0.05）。所有术式的临床相关术后胰瘘发生率均呈现持续显著下降，其中机器人辅助术式改善最为显著。微创术式住院时间显著缩短且死亡率更低，但机器人辅助远端胰腺切除术的手术时间长于腹腔镜远端胰腺切除术与开腹远端胰腺切除术。结论：过去十年间微创远端胰腺切除术应用持续增长而开腹远端胰腺切除术逐步减少。该增长初期由腹腔镜技术推动，2016年后趋于平台期，随后由机器人辅助技术接续驱动。具体而言，机器人辅助远端胰腺切除术呈现持续增长，而腹腔镜远端胰腺切除术在2016年左右出现下降趋势。这些发现揭示了临床实践模式的动态演变，且所有术式均伴随疗效改善，可为临床培训与资源配置提供参考依据。
Minimally Invasive Distal Pancreatectomy as the Standard of Care in the US: Are We There Yet?
肿瘤(癌症)患者之家