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van Hilst, Jony; de Rooij, Thijs; Klompmaker, Sjors; Rawashdeh, Majd; Aleotti, Francesca; Al-Sarireh, Bilal; Alseidi, Adnan; Ateeb, Zeeshan; Balzano, Gianpaolo; Berrevoet, Frederik; Björnsson, Bergthor; Boggi, Ugo; Busch, Olivier R; Butturini, Giovanni; Casadei, Riccardo; Del Chiaro, Marco; Chikhladze, Sophia; Cipriani, Federica; van Dam, Ronald; Damoli, Isacco; van Dieren, Susan; Dokmak, Safi; Edwin, Bjørn; van Eijck, Casper; Fabre, Jean-Marie; Falconi, Massimo; Farges, Olivier; Fernández-Cruz, Laureano; Forgione, Antonello; Frigerio, Isabella; Fuks, David; Gavazzi, Francesca; Gayet, Brice; Giardino, Alessandro; Groot Koerkamp, Bas; Hackert, Thilo; Hassenpflug, Matthias; Kabir, Irfan; Keck, Tobias; Khatkov, Igor; Kusar, Masa; Lombardo, Carlo; Marchegiani, Giovanni; Marshall, Ryne; Menon, Krish V; Montorsi, Marco; Orville, Marion; de Pastena, Matteo; Pietrabissa, Andrea; Poves, Ignaci; Primrose, John; Pugliese, Raffaele; Ricci, Claudio; Roberts, Keith; Røsok, Bård; Sahakyan, Mushegh A; Sánchez-Cabús, Santiago; Sandström, Per; Scovel, Lauren; Solaini, Leonardo; Soonawalla, Zahir; Souche, F Régis; Sutcliffe, Robert P; Tiberio, Guido A; Tomazic, Aleš; Troisi, Roberto; Wellner, Ulrich; White, Steven; Wittel, Uwe A; Zerbi, Alessandro; Bassi, Claudio; Besselink, Marc G; Abu Hilal, Mohammed
Annals of surgery, 2019-January, Volume: 269, Issue: 1Journal Article
OBJECTIVE:The aim of this study was to compare oncological outcomes after minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) in patients with pancreatic ductal adenocarcinoma (PDAC). BACKGROUND:Cohort studies have suggested superior short-term outcomes of MIDP vs. ODP. Recent international surveys, however, revealed that surgeons have concerns about the oncological outcomes of MIDP for PDAC. METHODS:This is a pan-European propensity score matched study including patients who underwent MIDP (laparoscopic or robot-assisted) or ODP for PDAC between January 1, 2007 and July 1, 2015. MIDP patients were matched to ODP patients in a 1:1 ratio. Main outcomes were radical (R0) resection, lymph node retrieval, and survival. RESULTS:In total, 1212 patients were included from 34 centers in 11 countries. Of 356 (29%) MIDP patients, 340 could be matched. After matching, the MIDP conversion rate was 19% (n = 62). Median blood loss 200 mL (60–400) vs 300 mL (150–500), P = 0.001 and hospital stay 8 (6–12) vs 9 (7–14) days, P < 0.001 were lower after MIDP. Clavien-Dindo grade ≥3 complications (18% vs 21%, P = 0.431) and 90-day mortality (2% vs 3%, P > 0.99) were comparable for MIDP and ODP, respectively. R0 resection rate was higher (67% vs 58%, P = 0.019), whereas Gerotaʼs fascia resection (31% vs 60%, P < 0.001) and lymph node retrieval 14 (8–22) vs 22 (14–31), P < 0.001 were lower after MIDP. Median overall survival was 28 95% confidence interval (CI), 22–34 versus 31 (95% CI, 26–36) months (P = 0.929). CONCLUSIONS:Comparable survival was seen after MIDP and ODP for PDAC, but the opposing differences in R0 resection rate, resection of Gerotaʼs fascia, and lymph node retrieval strengthen the need for a randomized trial to confirm the oncological safety of MIDP.
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