Sjors Klompmaker1, Jony van Hilst1, Ulrich F Wellner2,3, Olivier R Busch1, Andrea Coratti4, Mathieu D'Hondt5, Safi Dokmak6, Sebastiaan Festen7, Mustafa Kerem8, Igor Khatkov9, Daan J Lips10, Carlo Lombardo11, Misha Luyer12, Alberto Manzoni13, Izaäk Q Molenaar14, Edoardo Rosso13, Olivier Saint-Marc15, Franky Vansteenkiste5, Uwe A Wittel16, Bert Bonsing17, Bas Groot Koerkamp18, Mohammed Abu Hilal19, David Fuks20, Ignasi Poves21, Tobias Keck2,3, Ugo Boggi11, Marc G Besselink1. 1. Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, University of Amsterdam, the Netherlands. 2. Department of Surgery, UKSH Campus Lübeck, Lübeck, Germany. 3. Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Studien- Dokumentations- und Qualitätszentrum (StuDoQ|Pancreas), Berlin, Germany. 4. Department of Oncology and Robotic Surgery, Careggi University Hospital, Florence, Italy. 5. Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium. 6. Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France. 7. Department of Surgery, OLVG, Amsterdam, the Netherlands. 8. Department of General Surgery, School of Medicine, Gazi University, Ankara, Turkey. 9. Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia. 10. Department of Surgery, Jeroen Bosch Hospital, s-Hertogenbosch, the Netherlands. 11. Division of General and Transplant Surgery, University of Pisa, Pisa, Italy. 12. Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands. 13. Department of Surgery, Fondazione Poliambulanza - Istituto Ospedaliero, Brescia, Italy. 14. Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands. 15. Department of Surgery, Center Hospitalier Régional Orleans, Orleans, France. 16. Department of Visceral and General Surgery, University of Freiburg Medical Center, Freiburg, Germany. 17. Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands. 18. Department of Surgery, Erasmus MC, Rotterdam, the Netherlands. 19. Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom. 20. Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France. 21. Department of Surgery, Hospital del Mar, Barcelona, Spain.
Abstract
OBJECTIVE: To assess short-term outcomes after minimally invasive (laparoscopic, robot-assisted, and hybrid) pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) among European centers. BACKGROUND: Current evidence on MIPD is based on national registries or single expert centers. International, matched studies comparing outcomes for MIPD and OPD are lacking. METHODS: Retrospective propensity score matched study comparing MIPD in 14 centers (7 countries) performing ≥10 MIPDs annually (2012-2017) versus OPD in 53 German/Dutch surgical registry centers performing ≥10 OPDs annually (2014-2017). Primary outcome was 30-day major morbidity (Clavien-Dindo ≥3). RESULTS: Of 4220 patients, 729/730 MIPDs (412 laparoscopic, 184 robot-assisted, and 130 hybrid) were matched to 729 OPDs. Median annual case-volume was 19 MIPDs (interquartile range, IQR 13-22), including the first MIPDs performed in 10/14 centers, and 31 OPDs (IQR 21-38). Major morbidity (28% vs 30%, P = 0.526), mortality (4.0% vs 3.3%, P = 0.576), percutaneous drainage (12% vs 12%, P = 0.809), reoperation (11% vs 13%, P = 0.329), and hospital stay (mean 17 vs 17 days, P > 0.99) were comparable between MIPD and OPD. Grade-B/C postoperative pancreatic fistula (POPF) (23% vs 13%, P < 0.001) occurred more frequently after MIPD. Single-row pancreatojejunostomy was associated with POPF in MIPD (odds ratio, OR 2.95, P < 0.001), but not in OPD. Laparoscopic, robot-assisted, and hybrid MIPD had comparable major morbidity (27% vs 27% vs 35%), POPF (24% vs 19% vs 25%), and mortality (2.9% vs 5.2% vs 5.4%), with a fewer conversions in robot-assisted- versus laparoscopic MIPD (5% vs 26%, P < 0.001). CONCLUSIONS: In the early experience of 14 European centers performing ≥10 MIPDs annually, no differences were found in major morbidity, mortality, and hospital stay between MIPD and OPD. The high rates of POPF and conversion, and the lack of superior outcomes (ie, hospital stay, morbidity) could indicate that more experience and higher annual MIPD volumes are needed.
OBJECTIVE: To assess short-term outcomes after minimally invasive (laparoscopic, robot-assisted, and hybrid) pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) among European centers. BACKGROUND: Current evidence on MIPD is based on national registries or single expert centers. International, matched studies comparing outcomes for MIPD and OPD are lacking. METHODS: Retrospective propensity score matched study comparing MIPD in 14 centers (7 countries) performing ≥10 MIPDs annually (2012-2017) versus OPD in 53 German/Dutch surgical registry centers performing ≥10 OPDs annually (2014-2017). Primary outcome was 30-day major morbidity (Clavien-Dindo ≥3). RESULTS: Of 4220 patients, 729/730 MIPDs (412 laparoscopic, 184 robot-assisted, and 130 hybrid) were matched to 729 OPDs. Median annual case-volume was 19 MIPDs (interquartile range, IQR 13-22), including the first MIPDs performed in 10/14 centers, and 31 OPDs (IQR 21-38). Major morbidity (28% vs 30%, P = 0.526), mortality (4.0% vs 3.3%, P = 0.576), percutaneous drainage (12% vs 12%, P = 0.809), reoperation (11% vs 13%, P = 0.329), and hospital stay (mean 17 vs 17 days, P > 0.99) were comparable between MIPD and OPD. Grade-B/C postoperative pancreatic fistula (POPF) (23% vs 13%, P < 0.001) occurred more frequently after MIPD. Single-row pancreatojejunostomy was associated with POPF in MIPD (odds ratio, OR 2.95, P < 0.001), but not in OPD. Laparoscopic, robot-assisted, and hybrid MIPD had comparable major morbidity (27% vs 27% vs 35%), POPF (24% vs 19% vs 25%), and mortality (2.9% vs 5.2% vs 5.4%), with a fewer conversions in robot-assisted- versus laparoscopic MIPD (5% vs 26%, P < 0.001). CONCLUSIONS: In the early experience of 14 European centers performing ≥10 MIPDs annually, no differences were found in major morbidity, mortality, and hospital stay between MIPD and OPD. The high rates of POPF and conversion, and the lack of superior outcomes (ie, hospital stay, morbidity) could indicate that more experience and higher annual MIPD volumes are needed.