Long-term Outcomes After Laparoscopic, Robotic, and Open Pancreatoduodenectomy for Distal Cholangiocarcinoma

Abstract

Objective: This study aimed to compare surgical and oncological outcomes after minimally invasive pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) for distal cholangiocarcinoma (dCCA). Background: A dCCA might be a good indication for MIPD, as it is often diagnosed as primary resectable disease. However, multicenter series on MIPD for dCCA are lacking. Methods: This is an international multicenter propensity score-matched cohort study including patients after MIPD or OPD for dCCA in 8 centers from 5 countries (2010-2021). Primary outcomes included overall survival (OS) and disease-free interval (DFI). Secondary outcomes included perioperative and postoperative complications and predictors for OS or DFI. Subgroup analyses included robotic pancreatoduodenectomy (RPD) and laparoscopic pancreatoduodenectomy (LPD). Results: Overall, 478 patients after pancreatoduodenectomy for dCCA were included of which 97 after MIPD (37 RPD, 60 LPD) and 381 after OPD. MIPD was associated with less blood loss (300 vs 420 mL, P=0.025), longer operation time (453 vs 340 min; P<0.001), and less surgical site infections (7.8% vs 19.3%; P=0.042) compared with OPD. The median OS (30 vs 25 mo) and DFI (29 vs 18) for MIPD did not differ significantly between MIPD and OPD. Tumor stage (Hazard ratio: 2.939, P<0.001) and administration of adjuvant chemotherapy (Hazard ratio: 0.640, P=0.033) were individual predictors for OS. RPD was associated with a higher lymph node yield (18.0 vs 13.5; P=0.008) and less major morbidity (Clavien-Dindo 3b-5; 8.1% vs 32.1%; P=0.005) compared with LPD. Discussion: Both surgical and oncological outcomes of MIPD for dCCA are acceptable as compared with OPD. Surgical outcomes seem to favor RPD as compared with LPD but more data are needed. Randomized controlled trials should be performed to confirm these findings.

The State of Systematic Therapies in Clinic for Hepatobiliary Cancers

“…The mOS (30 vs 25 months) and DFS (29 vs 18 months) have no significant difference between MIPD and OPD, as the key to R0 resection was detailed medial perivascular dissection of the superior mesenteric artery (SMA) and perivenous tissue, as well as lymph node dissection. 157 The 5-year OS rates for patients who underwent R0 and R1/R2 resections were 60% and 8%, and for lymph node negative and positive patients were 58% and 21%, respectively. 158 The criteria for GBC resection include diseases localized to the gallbladder and/or adjacent liver (T1-3), with or without lymph nodes involvement in the hepatoduodenal ligament region (N1-2).…”

Comparative Outcomes of Minimally Invasive Versus Open Pancreatoduodenectomy in Distal Cholangiocarcinoma: A Systematic Review and Meta-Analysis

“…Meta-analysis was performed using R Software version 023.09.1+494 (R Foundation for Statistical Computing, Vienna, AUT) to calculate the effect size [ 23 ]. Effect sizes were presented as mean differences with a 95% CI.…”

“…Effect sizes were presented as mean differences with a 95% CI. The random‐effects model was used for pooling analysis to compensate for the heterogeneity of studies [ 23 , 24 ] statistics. In this regard, I2 ≥ 50% and ≥75% indicated substantial and considerable heterogeneity [ 24 ] study removal method to the subanalysis to assess whether any individual study exerted particular influence on the overall effect size [ 25 , 26 ]; p‐values < 0.05 were considered statistically significant.…”

“…All three studies report similar findings regarding long-term outcomes. Uijterwijk et al [ 23 ] and Kim et al [ 24 ] suggest that MIPD is comparable to OPD in terms of long-term outcomes, while Xu et al [ 25 ] indicates no significant differences in long-term survival between RPD and OPD groups.…”