Minimally-invasive versus open pancreatoduodenectomy: a Pan-European propensity-score matched analysis in high-volume centers

Abstract

Background: We assessed short-term outcomes after minimally invasive (laparoscopic, robot-assisted, hybrid) pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) among European high-volume (>10 MIPDs and >20 PDs overall per year) centers. Methods: Multicenter propensity-score-matched (1:1) retrospective study on MIPD vs OPD for (pre-)malignant tumors or cysts in 14 European MIPD centers (2012-2017) and OPD data from Dutch and German pancreatic surgery registries (2014-2017). Propensity scores were based on age, sex, BMI, ASA, comorbidities, ECOG, tumor location, suspected cancer, organ involvement, and venous resection. Primary outcome: 30-day major morbidity (Clavien-Dindo 3a-5). Secondary outcomes: grade-B/C pancreatic fistula (POPF), R1-resection (< 1 mm) margin, hospital stay and 30-day mortality. Results: Of 4220 included patients, all 730 MIPD (413 laparoscopic, 184 robot-assisted, 130 hybrid) were matched to 730 OPD. Major morbidity (28% vs 29%,

Initial experience with laparoscopic and robotic surgery for the treatment of periampullary tumours: single institution experience with the first 30 consecutive cases

“…The recent multi‐centre study from the United States, which looked at robotic reconstruction during the early learning curve, compared with the open technique showed no difference in anastomotic complications, suggesting that RPD can be adopted safely even during the learning phase. This was unlike the results of several studies on LDP, which suggested that there was an increase in morbidity such as pancreatic fistula over the open approach during the learning curve. Our present study seemed to support these findings whereby we could transition quickly from hybrid RPD to the totally MIS approach without experiencing any significant anastomotic complications.…”

“…MIPD involves not only a difficult and complex resection phase but also requires arguably the even more technically demanding reconstruction phase, in particular the creation of a secure pancreato‐enteric anastomoses. Several authors have raised concerns about the potential increase in morbidity and even mortality, especially during the early learning phase. In the study by Kutlu et al , the advantages of LPD, such as shorter hospital stay and lower readmission rate, become apparent only in high‐volume institutions performing more than 25 cases per year .…”

“…This is especially useful during the reconstruction phase of MIPD. Several studies have suggested that RPD is associated with a shorter learning curve and decreased open conversion rate compared to LPD, and is a valuable addition to the armamentarium of surgeons embarking on MIPD. The recent multi‐centre study from the United States, which looked at robotic reconstruction during the early learning curve, compared with the open technique showed no difference in anastomotic complications, suggesting that RPD can be adopted safely even during the learning phase.…”

Incidence and impact of Textbook Outcome among patients undergoing resection of pancreatic neuroendocrine tumors: Results of the US Neuroendocrine Tumor Study Group

“…Surgery remains the only chance of long‐term cure, yet can be associated with considerable perioperative morbidity 6,9 . Traditionally, a number of metrics have been used to assess the quality of surgical care delivered to patients 6,9,18 . Recently, however, investigators have suggested that composite outcome measures may be superior to individual outcome parameters to assess hospital performance and current practices.…”

Minimally invasive versus open distal pancreatectomy for pancreatic neuroendocrine tumors: An analysis from the U.S. neuroendocrine tumor study group

“…Because the first laparoscopic pancreatic surgery performed by Cuschieri in 1994, laparoscopic surgery has been increasingly utilized in pancreatic surgery because of its minimal invasiveness versus open procedures . Because of its overall relatively low incidence, the assessment of short‐ and long‐term outcomes after laparoscopic versus open surgery for pNET have been limited.…”