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 Damoli; Susan 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)

doi:10.1097/SLA.0000000000002561

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 journal › Article › peer-review

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 language	English
Pages (from-to)	10-17
Number of pages	8
Journal	Ann. Surg.
Volume	269
Issue number	1
DOIs	https://doi.org/10.1097/SLA.0000000000002561
Publication status	Published - Jan 2019

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

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10.1097/SLA.0000000000002561

https://pubmed.ncbi.nlm.nih.gov/29099399

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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

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; 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; (E-MIPS), European Consortium on Minimally Invasive Pancreatic Surgery.

In: Ann. Surg., Vol. 269, No. 1, 01.2019, p. 10-17.

Research output: Contribution to journal › Article › peer-review

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, Groot Koerkamp, B, Hackert, T, Hassenpflug, M, Kabir, I, Keck, T, Khatkov, I, Kusar, M, Lombardo, C, Marchegiani, G, Marshall, R, Menon, KV, Montorsi, M, Orville, M, de Pastena, M, Pietrabissa, A, Poves, I, Primrose, J, Pugliese, R, Ricci, C, Roberts, K, Røsok, B, Sahakyan, MA, Sánchez-Cabús, S, Sandström, P, Scovel, L, Solaini, L, Soonawalla, Z, Souche, FR, Sutcliffe, RP, Tiberio, GA, Tomazic, A, Troisi, R, Wellner, U, White, S, Wittel, UA, Zerbi, A, Bassi, C, Besselink, MG, Abu Hilal, M & (E-MIPS), ECOMIPS 2019, 'Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA): A Pan-European Propensity Score Matched Study', Ann. Surg., vol. 269, no. 1, pp. 10-17. 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 ; 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 ; (E-MIPS), European Consortium on Minimally Invasive Pancreatic Surgery. / Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA): A Pan-European Propensity Score Matched Study. In: Ann. Surg. 2019 ; Vol. 269, No. 1. pp. 10-17.

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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 = "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",

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 {Groot Koerkamp}, Bas 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 {de Pastena}, Matteo and Andrea Pietrabissa and Ignaci Poves and John Primrose and Raffaele Pugliese and Claudio Ricci and Keith Roberts and B{\aa}rd R{\o}sok and Sahakyan, {Mushegh A} and Santiago S{\'a}nchez-Cab{\'u}s and Per Sandstr{\"o}m and Lauren Scovel and Leonardo Solaini and Zahir Soonawalla and Souche, {F R{\'e}gis} and Sutcliffe, {Robert P} and Tiberio, {Guido A} and Ale{\v s} Tomazic and Roberto Troisi and Ulrich Wellner and Steven White and Wittel, {Uwe A} and Alessandro Zerbi and Claudio Bassi and Besselink, {Marc G} and {Abu Hilal}, Mohammed and (E-MIPS), {European Consortium on Minimally Invasive Pancreatic Surgery}",

year = "2019",

month = jan,

doi = "10.1097/SLA.0000000000002561",

language = "English",

volume = "269",

pages = "10--17",

journal = "Ann. Surg.",

issn = "1528-1140",

publisher = "NLM (Medline)",

number = "1",

}

TY - JOUR

T1 - Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA): 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 - Groot Koerkamp, Bas

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 - de Pastena, Matteo

AU - Pietrabissa, Andrea

AU - Poves, Ignaci

AU - Primrose, John

AU - Pugliese, Raffaele

AU - Ricci, Claudio

AU - Roberts, Keith

AU - Røsok, Bård

AU - Sahakyan, Mushegh A

AU - Sánchez-Cabús, Santiago

AU - Sandström, Per

AU - Scovel, Lauren

AU - Solaini, Leonardo

AU - Soonawalla, Zahir

AU - Souche, F Régis

AU - Sutcliffe, Robert P

AU - Tiberio, Guido A

AU - Tomazic, Aleš

AU - Troisi, Roberto

AU - Wellner, Ulrich

AU - White, Steven

AU - Wittel, Uwe A

AU - Zerbi, Alessandro

AU - Bassi, Claudio

AU - Besselink, Marc G

AU - Abu Hilal, Mohammed

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

PY - 2019/1

Y1 - 2019/1

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 - Aged

KW - Carcinoma, Pancreatic Ductal/diagnosis/mortality/surgery

KW - Europe/epidemiology

KW - Female

KW - Humans

KW - Incidence

KW - Laparoscopy/methods

KW - Length of Stay/trends

KW - Male

KW - Minimally Invasive Surgical Procedures/methods

KW - Neoplasm Staging

KW - Pancreatectomy/methods

KW - Pancreatic Neoplasms/diagnosis/mortality/surgery

KW - Postoperative Complications/epidemiology

KW - Propensity Score

KW - Retrospective Studies

KW - Robotic Surgical Procedures/methods

KW - Survival Rate/trends

KW - Treatment Outcome

U2 - 10.1097/SLA.0000000000002561

DO - 10.1097/SLA.0000000000002561

M3 - Article

VL - 269

SP - 10

EP - 17

JO - Ann. Surg.

JF - Ann. Surg.

SN - 1528-1140

IS - 1

ER -