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Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA): a pan-European propensity score matched study

Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA): a pan-European propensity score matched study
Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA): a pan-European propensity score matched study

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.

Journal Article
0003-4932
10-17
van Hilst, Jony
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de Rooij, Thijs
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Giardino, Alessandro
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Bas Groot, Koerkamp
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Lombardo, Carlo
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Marchegiani, Giovanni
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Marshall, Ryne
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Menon, Krish V
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Orville, Marion
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de Pastena, Matteo
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Primrose, John
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Abu-Hilal, Mohammed
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European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)
van Hilst, Jony
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de Rooij, Thijs
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Klompmaker, Sjors
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Rawashdeh, Majd
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Aleotti, Francesca
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Al-Sarireh, Bilal
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Alseidi, Adnan
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Ateeb, Zeeshan
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Berrevoet, Frederik
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Björnsson, Bergthor
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Boggi, Ugo
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Busch, Olivier R
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Butturini, Giovanni
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Casadei, Riccardo
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Del Chiaro, Marco
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Chikhladze, Sophia
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Cipriani, Federica
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van Dam, Ronald
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Damoli, Isacco
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van Dieren, Susan
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Dokmak, Safi
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Edwin, Bjørn
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van Eijck, Casper
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Fabre, Jean-Marie
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Falconi, Massimo
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Farges, Olivier
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Fernández-Cruz, Laureano
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Forgione, Antonello
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Frigerio, Isabella
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Fuks, David
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Giardino, Alessandro
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Bas Groot, Koerkamp
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Hackert, Thilo
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Hassenpflug, Matthias
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Kabir, Irfan
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Keck, Tobias
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Montorsi, Marco
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Orville, Marion
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de Pastena, Matteo
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Primrose, John
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Abu-Hilal, Mohammed
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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, Bas Groot, Koerkamp, 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, Primrose, John and Abu-Hilal, Mohammed , European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS) (2019) Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA): a pan-European propensity score matched study. Annals of Surgery, 269 (1), 10-17. (doi:10.1097/SLA.0000000000002561).

Record type: Article

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.

Text
van Hilst et al - DIPLOMA cohort study - Manuscript - vF - Accepted Manuscript
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Accepted/In Press date: 23 September 2017
e-pub ahead of print date: 2 November 2017
Published date: 1 January 2019
Keywords: Journal Article

Identifiers

Local EPrints ID: 416033
URI: http://eprints.soton.ac.uk/id/eprint/416033
DOI: doi:10.1097/SLA.0000000000002561
ISSN: 0003-4932
PURE UUID: 700cd903-cef0-4a44-9f69-323041a547f7
ORCID for John Primrose: ORCID iD orcid.org/0000-0002-2069-7605

Catalogue record

Date deposited: 30 Nov 2017 17:30
Last modified: 16 Mar 2024 05:58

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Contributors

Author: Jony van Hilst
Author: Thijs de Rooij
Author: Sjors Klompmaker
Author: Majd Rawashdeh
Author: Francesca Aleotti
Author: Bilal Al-Sarireh
Author: Adnan Alseidi
Author: Zeeshan Ateeb
Author: Gianpaolo Balzano
Author: Frederik Berrevoet
Author: Bergthor Björnsson
Author: Ugo Boggi
Author: Olivier R Busch
Author: Giovanni Butturini
Author: Riccardo Casadei
Author: Marco Del Chiaro
Author: Sophia Chikhladze
Author: Federica Cipriani
Author: Ronald van Dam
Author: Isacco Damoli
Author: Susan van Dieren
Author: Safi Dokmak
Author: Bjørn Edwin
Author: Casper van Eijck
Author: Jean-Marie Fabre
Author: Massimo Falconi
Author: Olivier Farges
Author: Laureano Fernández-Cruz
Author: Antonello Forgione
Author: Isabella Frigerio
Author: David Fuks
Author: Francesca Gavazzi
Author: Brice Gayet
Author: Alessandro Giardino
Author: Koerkamp Bas Groot
Author: Thilo Hackert
Author: Matthias Hassenpflug
Author: Irfan Kabir
Author: Tobias Keck
Author: Igor Khatkov
Author: Masa Kusar
Author: Carlo Lombardo
Author: Giovanni Marchegiani
Author: Ryne Marshall
Author: Krish V Menon
Author: Marco Montorsi
Author: Marion Orville
Author: Matteo de Pastena
Author: John Primrose ORCID iD
Author: Mohammed Abu-Hilal
Corporate Author: European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)

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