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, Bas Groot Koerkamp, 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, Matteo de Pastena, Andrea Pietrabissa, Ignaci Poves, John Primrose, Raffaele Pugliese, Claudio Ricci, Keith Roberts, Bård Røsok, Mushegh A Sahakyan, Santiago Sánchez-Cabús, Per Sandström, Lauren Scovel, Leonardo Solaini, Zahir Soonawalla, F Régis Souche, Robert P Sutcliffe, Guido A Tiberio, Aleš Tomazic, Roberto Troisi, Ulrich Wellner, Steven White, Uwe A Wittel, Alessandro Zerbi, Claudio Bassi, Marc G Besselink, Mohammed Abu Hilal, 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
Pages (from-to)10-17
Number of pages8
JournalAnn. Surg.
Volume269
Issue number1
DOIs
Publication statusPublished - Jan 2019

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Keywords

  • Aged
  • Carcinoma, Pancreatic Ductal/diagnosis/mortality/*surgery
  • Europe/epidemiology
  • Female
  • Humans
  • Incidence
  • Laparoscopy/methods
  • Length of Stay/trends
  • Male
  • Minimally Invasive Surgical Procedures/*methods
  • Neoplasm Staging
  • Pancreatectomy/*methods
  • Pancreatic Neoplasms/diagnosis/mortality/*surgery
  • Postoperative Complications/epidemiology
  • *Propensity Score
  • Retrospective Studies
  • Robotic Surgical Procedures/methods
  • Survival Rate/trends
  • Treatment Outcome

Cite this

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, O. R., Butturini, G., Casadei, R., Del Chiaro, M., Chikhladze, S., Cipriani, F., van Dam, R., ... (E-MIPS), E. C. O. M. I. P. S. (2019). Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA): A Pan-European Propensity Score Matched Study. Ann. Surg., 269(1), 10-17. https://doi.org/10.1097/SLA.0000000000002561