Back to Search
Start Over
Outcomes After Minimally-invasive Versus Open Pancreatoduodenectomy: A Pan-European Propensity Score Matched Study
- Source :
- Annals of surgery, 271(2), 356-363. Lippincott Williams and Wilkins, Annals of Surgery, 271, 356-363. Lippincott Williams & Wilkins, Annals of Surgery, 271(2), 356-363. LIPPINCOTT WILLIAMS & WILKINS
- Publication Year :
- 2020
-
Abstract
- OBJECTIVE: To assess short-term outcomes after minimally invasive (laparoscopic, robot-assisted, and hybrid) pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) among European centers. BACKGROUND: Current evidence on MIPD is based on national registries or single expert centers. International, matched studies comparing outcomes for MIPD and OPD are lacking. METHODS: Retrospective propensity score matched study comparing MIPD in 14 centers (7 countries) performing ≥10 MIPDs annually (2012-2017) versus OPD in 53 German/Dutch surgical registry centers performing ≥10 OPDs annually (2014-2017). Primary outcome was 30-day major morbidity (Clavien-Dindo ≥3). RESULTS: Of 4220 patients, 729/730 MIPDs (412 laparoscopic, 184 robot-assisted, and 130 hybrid) were matched to 729 OPDs. Median annual case-volume was 19 MIPDs (interquartile range, IQR 13-22), including the first MIPDs performed in 10/14 centers, and 31 OPDs (IQR 21-38). Major morbidity (28% vs 30%, P = 0.526), mortality (4.0% vs 3.3%, P = 0.576), percutaneous drainage (12% vs 12%, P = 0.809), reoperation (11% vs 13%, P = 0.329), and hospital stay (mean 17 vs 17 days, P > 0.99) were comparable between MIPD and OPD. Grade-B/C postoperative pancreatic fistula (POPF) (23% vs 13%, P < 0.001) occurred more frequently after MIPD. Single-row pancreatojejunostomy was associated with POPF in MIPD (odds ratio, OR 2.95, P < 0.001), but not in OPD. Laparoscopic, robot-assisted, and hybrid MIPD had comparable major morbidity (27% vs 27% vs 35%), POPF (24% vs 19% vs 25%), and mortality (2.9% vs 5.2% vs 5.4%), with a fewer conversions in robot-assisted- versus laparoscopic MIPD (5% vs 26%, P < 0.001). CONCLUSIONS: In the early experience of 14 European centers performing ≥10 MIPDs annually, no differences were found in major morbidity, mortality, and hospital stay between MIPD and OPD. The high rates of POPF and conversion, and the lack of superior outcomes (ie, hospital stay, morbidity) could indicate that more experience and higher annual MIPD volumes are needed.
- Subjects :
- Male
robotic
medicine.medical_specialty
Percutaneous
pancreatic cancer
pancreatic tumors
laparoscopic
Pancreaticoduodenectomy
surgery
03 medical and health sciences
0302 clinical medicine
Pan european
Interquartile range
medicine
Humans
Minimally Invasive Surgical Procedures
pancreas
Propensity Score
Aged
Retrospective Studies
High rate
hybrid
propensity score matching
business.industry
Pancreatic Diseases
Retrospective cohort study
robot
Odds ratio
Length of Stay
Middle Aged
medicine.disease
Whipple
Surgery
Europe
Outcome and Process Assessment, Health Care
Pancreatic fistula
030220 oncology & carcinogenesis
Propensity score matching
minimally invasive
Female
030211 gastroenterology & hepatology
business
Subjects
Details
- Language :
- English
- ISSN :
- 00034932
- Database :
- OpenAIRE
- Journal :
- Annals of surgery, 271(2), 356-363. Lippincott Williams and Wilkins, Annals of Surgery, 271, 356-363. Lippincott Williams & Wilkins, Annals of Surgery, 271(2), 356-363. LIPPINCOTT WILLIAMS & WILKINS
- Accession number :
- edsair.doi.dedup.....b18fdffcb7c9b0f540e6d9d0daa1ccff