Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA): A Pan-European Propensity Score Matched Study

Jony van Hilst, Thijs de Rooij, Sjors Klompmaker, Majd Rawashdeh, Francesca Aleotti, Bilal Al-Sarireh, Adnan Alseidi, Zeeshan Ateeb, Gianpaolo Balzano, Frederik Berrevoet, Bergthor Björnsson, Ugo Boggi, Olivier R Busch, Giovanni Butturini, Riccardo Casadei, Marco Del Chiaro, Sophia Chikhladze, Federica Cipriani, Ronald van Dam, Isacco DamoliSusan van Dieren, Safi Dokmak, Bjørn Edwin, Casper van Eijck, Jean-Marie Fabre, Massimo Falconi, Olivier Farges, Laureano Fernández-Cruz, Antonello Forgione, Isabella Frigerio, David Fuks, Francesca Gavazzi, Brice Gayet, Alessandro Giardino, Koerkamp Bas Groot, Thilo Hackert, Matthias Hassenpflug, Irfan Kabir, Tobias Keck, Igor Khatkov, Masa Kusar, Carlo Lombardo, Giovanni Marchegiani, Ryne Marshall, Krish V Menon, Marco Montorsi, Marion Orville, Andrea Pietrabissa, Raffaele Pugliese, Alessandro Zerbi, European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)

Research output: Contribution to journalArticle

Abstract

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 Gerota's 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 Gerota's fascia, and lymph node retrieval strengthen the need for a randomized trial to confirm the oncological safety of MIDP.

Original languageEnglish
JournalAnnals of Surgery
DOIs
Publication statusE-pub ahead of print - Nov 2 2017

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Propensity Score
Pancreatectomy
Adenocarcinoma
Lymph Nodes
Fascia
Survival
Confidence Intervals

Keywords

  • Journal Article

Cite this

van Hilst, J., de Rooij, T., Klompmaker, S., Rawashdeh, M., Aleotti, F., Al-Sarireh, B., ... European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS) (2017). Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA): A Pan-European Propensity Score Matched Study. Annals of Surgery. https://doi.org/10.1097/SLA.0000000000002561

Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA) : A Pan-European Propensity Score Matched Study. / 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; Bas Groot, Koerkamp; 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; Pietrabissa, Andrea; Pugliese, Raffaele; Zerbi, Alessandro; European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS).

In: Annals of Surgery, 02.11.2017.

Research output: Contribution to journalArticle

van Hilst, J, de Rooij, T, Klompmaker, S, Rawashdeh, M, Aleotti, F, Al-Sarireh, B, Alseidi, A, Ateeb, Z, Balzano, G, Berrevoet, F, Björnsson, B, Boggi, U, Busch, OR, Butturini, G, Casadei, R, Del Chiaro, M, Chikhladze, S, Cipriani, F, van Dam, R, Damoli, I, van Dieren, S, Dokmak, S, Edwin, B, van Eijck, C, Fabre, J-M, Falconi, M, Farges, O, Fernández-Cruz, L, Forgione, A, Frigerio, I, Fuks, D, Gavazzi, F, Gayet, B, Giardino, A, Bas Groot, K, Hackert, T, Hassenpflug, M, Kabir, I, Keck, T, Khatkov, I, Kusar, M, Lombardo, C, Marchegiani, G, Marshall, R, Menon, KV, Montorsi, M, Orville, M, Pietrabissa, A, Pugliese, R, Zerbi, A & European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS) 2017, 'Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA): A Pan-European Propensity Score Matched Study', Annals of Surgery. https://doi.org/10.1097/SLA.0000000000002561
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 ; Bas Groot, Koerkamp ; 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 ; Pietrabissa, Andrea ; Pugliese, Raffaele ; Zerbi, Alessandro ; European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS). / Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA) : A Pan-European Propensity Score Matched Study. In: Annals of Surgery. 2017.
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title = "Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA): A Pan-European Propensity Score Matched Study",
abstract = "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 Gerota's 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 Gerota's fascia, and lymph node retrieval strengthen the need for a randomized trial to confirm the oncological safety of MIDP.",
keywords = "Journal Article",
author = "{van Hilst}, Jony and {de Rooij}, Thijs and Sjors Klompmaker and Majd Rawashdeh and Francesca Aleotti and Bilal Al-Sarireh and Adnan Alseidi and Zeeshan Ateeb and Gianpaolo Balzano and Frederik Berrevoet and Bergthor Bj{\"o}rnsson and Ugo Boggi and Busch, {Olivier R} and Giovanni Butturini and Riccardo Casadei and {Del Chiaro}, Marco and Sophia Chikhladze and Federica Cipriani and {van Dam}, Ronald and Isacco Damoli and {van Dieren}, Susan and Safi Dokmak and Bj{\o}rn Edwin and {van Eijck}, Casper and Jean-Marie Fabre and Massimo Falconi and Olivier Farges and Laureano Fern{\'a}ndez-Cruz and Antonello Forgione and Isabella Frigerio and David Fuks and Francesca Gavazzi and Brice Gayet and Alessandro Giardino and {Bas Groot}, Koerkamp and Thilo Hackert and Matthias Hassenpflug and Irfan Kabir and Tobias Keck and Igor Khatkov and Masa Kusar and Carlo Lombardo and Giovanni Marchegiani and Ryne Marshall and Menon, {Krish V} and Marco Montorsi and Marion Orville and Andrea Pietrabissa and Raffaele Pugliese and Alessandro Zerbi and {European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)}",
year = "2017",
month = "11",
day = "2",
doi = "10.1097/SLA.0000000000002561",
language = "English",
journal = "Annals of Surgery",
issn = "0003-4932",
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TY - JOUR

T1 - Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA)

T2 - A Pan-European Propensity Score Matched Study

AU - van Hilst, Jony

AU - de Rooij, Thijs

AU - Klompmaker, Sjors

AU - Rawashdeh, Majd

AU - Aleotti, Francesca

AU - Al-Sarireh, Bilal

AU - Alseidi, Adnan

AU - Ateeb, Zeeshan

AU - Balzano, Gianpaolo

AU - Berrevoet, Frederik

AU - Björnsson, Bergthor

AU - Boggi, Ugo

AU - Busch, Olivier R

AU - Butturini, Giovanni

AU - Casadei, Riccardo

AU - Del Chiaro, Marco

AU - Chikhladze, Sophia

AU - Cipriani, Federica

AU - van Dam, Ronald

AU - Damoli, Isacco

AU - van Dieren, Susan

AU - Dokmak, Safi

AU - Edwin, Bjørn

AU - van Eijck, Casper

AU - Fabre, Jean-Marie

AU - Falconi, Massimo

AU - Farges, Olivier

AU - Fernández-Cruz, Laureano

AU - Forgione, Antonello

AU - Frigerio, Isabella

AU - Fuks, David

AU - Gavazzi, Francesca

AU - Gayet, Brice

AU - Giardino, Alessandro

AU - Bas Groot, Koerkamp

AU - Hackert, Thilo

AU - Hassenpflug, Matthias

AU - Kabir, Irfan

AU - Keck, Tobias

AU - Khatkov, Igor

AU - Kusar, Masa

AU - Lombardo, Carlo

AU - Marchegiani, Giovanni

AU - Marshall, Ryne

AU - Menon, Krish V

AU - Montorsi, Marco

AU - Orville, Marion

AU - Pietrabissa, Andrea

AU - Pugliese, Raffaele

AU - Zerbi, Alessandro

AU - European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)

PY - 2017/11/2

Y1 - 2017/11/2

N2 - 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 Gerota's 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 Gerota's fascia, and lymph node retrieval strengthen the need for a randomized trial to confirm the oncological safety of MIDP.

AB - 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 Gerota's 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 Gerota's fascia, and lymph node retrieval strengthen the need for a randomized trial to confirm the oncological safety of MIDP.

KW - Journal Article

U2 - 10.1097/SLA.0000000000002561

DO - 10.1097/SLA.0000000000002561

M3 - Article

C2 - 29099399

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

ER -