Laparoscopic versus open extended radical left pancreatectomy for pancreatic ductal adenocarcinoma: an international propensity-score matched study

A. Balduzzi; J. van Hilst; M. Korrel; S. Lof; B. Al-Sarireh; A. Alseidi; F. Berrevoet; B. Bjornsson; P. van den Boezem; U. Boggi; O.R. Busch; G. Butturini; R. Casadei; R. van Dam; S. Dokmak; B. Edwin; M.A. Sahakyan; G. Ercolani; J.M. Fabre; M. Falconi; A. Forgione; B. Gayet; D. Gomez; B.G. Koerkamp; T. Hackert; T. Keck; I. Khatkov; C. Krautz; R. Marudanayagam; K. Menon; A. Pietrabissa; I. Poves; A.S. Cunha; R. Salvia; S. Sanchez-Cabus; Z. Soonawalla; M. Abu Hilal; M.G. Besselink; European Consortium on Minimally Invasive Pancreatic Surgery (E- MIPS)

doi:10.1007/s00464-020-08206-y

Laparoscopic versus open extended radical left pancreatectomy for pancreatic ductal adenocarcinoma: an international propensity-score matched study

A. Balduzzi^*, J. van Hilst, M. Korrel, S. Lof, B. Al-Sarireh, A. Alseidi, F. Berrevoet, B. Bjornsson, P. van den Boezem, U. Boggi, O.R. Busch, G. Butturini, R. Casadei, R. van Dam, S. Dokmak, B. Edwin, M.A. Sahakyan, G. Ercolani, J.M. Fabre, M. FalconiA. Forgione, B. Gayet, D. Gomez, B.G. Koerkamp, T. Hackert, T. Keck, I. Khatkov, C. Krautz, R. Marudanayagam, K. Menon, A. Pietrabissa, I. Poves, A.S. Cunha, R. Salvia, S. Sanchez-Cabus, Z. Soonawalla, M. Abu Hilal^*, M.G. Besselink^*, European Consortium on Minimally Invasive Pancreatic Surgery (E- MIPS)

^*Corresponding author for this work

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

Abstract

Background A radical left pancreatectomy in patients with pancreatic ductal adenocarcinoma (PDAC) may require extended, multivisceral resections. The role of a laparoscopic approach in extended radical left pancreatectomy (ERLP) is unclear since comparative studies are lacking. The aim of this study was to compare outcomes after laparoscopic vs open ERLP in patients with PDAC. Methods An international multicenter propensity-score matched study including patients who underwent either laparoscopic or open ERLP (L-ERLP; O-ERLP) for PDAC was performed (2007-2015). The ISGPS definition for extended resection was used. Primary outcomes were overall survival, margin negative rate (R0), and lymph node retrieval. Results Between 2007 and 2015, 320 patients underwent ERLP in 34 centers from 12 countries (65 L-ERLP vs. 255 O-ERLP). After propensity-score matching, 44 L-ERLP could be matched to 44 O-ERLP. In the matched cohort, the conversion rate in L-ERLP group was 35%. The L-ERLP R0 resection rate (matched cohort) was comparable to O-ERLP (67% vs 48%; P = 0.063) but the lymph node yield was lower for L-ERLP than O-ERLP (median 11 vs 19, P = 0.023). L-ERLP was associated with less delayed gastric emptying (0% vs 16%, P = 0.006) and shorter hospital stay (median 9 vs 13 days, P = 0.005), as compared to O-ERLP. Outcomes were comparable for additional organ resections, vascular resections (besides splenic vessels), Clavien-Dindo grade >= III complications, or 90-day mortality (2% vs 2%, P = 0.973). The median overall survival was comparable between both groups (19 vs 20 months, P = 0.571). Conversion did not worsen outcomes in L-ERLP. Conclusion The laparoscopic approach may be used safely in selected patients requiring ERLP for PDAC, since morbidity, mortality, and overall survival seem comparable, as compared to O-ERLP. L-ERLP is associated with a high conversion rate and reduced lymph node yield but also with less delayed gastric emptying and a shorter hospital stay, as compared to O-ERLP.

Original language	English
Pages (from-to)	6949-6959
Number of pages	11
Journal	Surgical endoscopy and other interventional techniques
Volume	35
Issue number	12
Early online date	4 Jan 2021
DOIs	https://doi.org/10.1007/s00464-020-08206-y
Publication status	Published - Dec 2021

Keywords

cancer
classification
cohort
definition
distal pancreatectomy
erlp
extended resection
left pancreatectomy
pancreatosplenectomy
pdac
surgery
surgical complications
SURGERY
DEFINITION
PANCREATOSPLENECTOMY
CLASSIFICATION
Left pancreatectomy
CANCER
ERLP
SURGICAL COMPLICATIONS
PDAC
DISTAL PANCREATECTOMY
COHORT
Extended resection

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10.1007/s00464-020-08206-y

Cite this

Balduzzi, A., van Hilst, J., Korrel, M., Lof, S., Al-Sarireh, B., Alseidi, A., Berrevoet, F., Bjornsson, B., van den Boezem, P., Boggi, U., Busch, O. R., Butturini, G., Casadei, R., van Dam, R., Dokmak, S., Edwin, B., Sahakyan, M. A., Ercolani, G., Fabre, J. M., ... European Consortium on Minimally Invasive Pancreatic Surgery (E- MIPS) (2021). Laparoscopic versus open extended radical left pancreatectomy for pancreatic ductal adenocarcinoma: an international propensity-score matched study. Surgical endoscopy and other interventional techniques, 35(12), 6949-6959. https://doi.org/10.1007/s00464-020-08206-y

@article{00d9e5c0591948f280a9d6047e80323a,

title = "Laparoscopic versus open extended radical left pancreatectomy for pancreatic ductal adenocarcinoma: an international propensity-score matched study",

abstract = "Background A radical left pancreatectomy in patients with pancreatic ductal adenocarcinoma (PDAC) may require extended, multivisceral resections. The role of a laparoscopic approach in extended radical left pancreatectomy (ERLP) is unclear since comparative studies are lacking. The aim of this study was to compare outcomes after laparoscopic vs open ERLP in patients with PDAC. Methods An international multicenter propensity-score matched study including patients who underwent either laparoscopic or open ERLP (L-ERLP; O-ERLP) for PDAC was performed (2007-2015). The ISGPS definition for extended resection was used. Primary outcomes were overall survival, margin negative rate (R0), and lymph node retrieval. Results Between 2007 and 2015, 320 patients underwent ERLP in 34 centers from 12 countries (65 L-ERLP vs. 255 O-ERLP). After propensity-score matching, 44 L-ERLP could be matched to 44 O-ERLP. In the matched cohort, the conversion rate in L-ERLP group was 35%. The L-ERLP R0 resection rate (matched cohort) was comparable to O-ERLP (67% vs 48%; P = 0.063) but the lymph node yield was lower for L-ERLP than O-ERLP (median 11 vs 19, P = 0.023). L-ERLP was associated with less delayed gastric emptying (0% vs 16%, P = 0.006) and shorter hospital stay (median 9 vs 13 days, P = 0.005), as compared to O-ERLP. Outcomes were comparable for additional organ resections, vascular resections (besides splenic vessels), Clavien-Dindo grade >= III complications, or 90-day mortality (2% vs 2%, P = 0.973). The median overall survival was comparable between both groups (19 vs 20 months, P = 0.571). Conversion did not worsen outcomes in L-ERLP. Conclusion The laparoscopic approach may be used safely in selected patients requiring ERLP for PDAC, since morbidity, mortality, and overall survival seem comparable, as compared to O-ERLP. L-ERLP is associated with a high conversion rate and reduced lymph node yield but also with less delayed gastric emptying and a shorter hospital stay, as compared to O-ERLP.",

keywords = "cancer, classification, cohort, definition, distal pancreatectomy, erlp, extended resection, left pancreatectomy, pancreatosplenectomy, pdac, surgery, surgical complications, SURGERY, DEFINITION, PANCREATOSPLENECTOMY, CLASSIFICATION, Left pancreatectomy, CANCER, ERLP, SURGICAL COMPLICATIONS, PDAC, DISTAL PANCREATECTOMY, COHORT, Extended resection",

author = "A. Balduzzi and {van Hilst}, J. and M. Korrel and S. Lof and B. Al-Sarireh and A. Alseidi and F. Berrevoet and B. Bjornsson and {van den Boezem}, P. and U. Boggi and O.R. Busch and G. Butturini and R. Casadei and {van Dam}, R. and S. Dokmak and B. Edwin and M.A. Sahakyan and G. Ercolani and J.M. Fabre and M. Falconi and A. Forgione and B. Gayet and D. Gomez and B.G. Koerkamp and T. Hackert and T. Keck and I. Khatkov and C. Krautz and R. Marudanayagam and K. Menon and A. Pietrabissa and I. Poves and A.S. Cunha and R. Salvia and S. Sanchez-Cabus and Z. Soonawalla and {Abu Hilal}, M. and M.G. Besselink and {European Consortium on Minimally Invasive Pancreatic Surgery (E- MIPS)}",

year = "2021",

month = dec,

doi = "10.1007/s00464-020-08206-y",

language = "English",

volume = "35",

pages = "6949--6959",

journal = "Surgical endoscopy and other interventional techniques",

issn = "0930-2794",

publisher = "Springer, Cham",

number = "12",

}

Balduzzi, A, van Hilst, J, Korrel, M, Lof, S, Al-Sarireh, B, Alseidi, A, Berrevoet, F, Bjornsson, B, van den Boezem, P, Boggi, U, Busch, OR, Butturini, G, Casadei, R, van Dam, R, Dokmak, S, Edwin, B, Sahakyan, MA, Ercolani, G, Fabre, JM, Falconi, M, Forgione, A, Gayet, B, Gomez, D, Koerkamp, BG, Hackert, T, Keck, T, Khatkov, I, Krautz, C, Marudanayagam, R, Menon, K, Pietrabissa, A, Poves, I, Cunha, AS, Salvia, R, Sanchez-Cabus, S, Soonawalla, Z, Abu Hilal, M, Besselink, MG & European Consortium on Minimally Invasive Pancreatic Surgery (E- MIPS) 2021, 'Laparoscopic versus open extended radical left pancreatectomy for pancreatic ductal adenocarcinoma: an international propensity-score matched study', Surgical endoscopy and other interventional techniques, vol. 35, no. 12, pp. 6949-6959. https://doi.org/10.1007/s00464-020-08206-y

Laparoscopic versus open extended radical left pancreatectomy for pancreatic ductal adenocarcinoma: an international propensity-score matched study. / Balduzzi, A.; van Hilst, J.; Korrel, M. et al.
In: Surgical endoscopy and other interventional techniques, Vol. 35, No. 12, 12.2021, p. 6949-6959.

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

TY - JOUR

T1 - Laparoscopic versus open extended radical left pancreatectomy for pancreatic ductal adenocarcinoma: an international propensity-score matched study

AU - Balduzzi, A.

AU - van Hilst, J.

AU - Korrel, M.

AU - Lof, S.

AU - Al-Sarireh, B.

AU - Alseidi, A.

AU - Berrevoet, F.

AU - Bjornsson, B.

AU - van den Boezem, P.

AU - Boggi, U.

AU - Busch, O.R.

AU - Butturini, G.

AU - Casadei, R.

AU - van Dam, R.

AU - Dokmak, S.

AU - Edwin, B.

AU - Sahakyan, M.A.

AU - Ercolani, G.

AU - Fabre, J.M.

AU - Falconi, M.

AU - Forgione, A.

AU - Gayet, B.

AU - Gomez, D.

AU - Koerkamp, B.G.

AU - Hackert, T.

AU - Keck, T.

AU - Khatkov, I.

AU - Krautz, C.

AU - Marudanayagam, R.

AU - Menon, K.

AU - Pietrabissa, A.

AU - Poves, I.

AU - Cunha, A.S.

AU - Salvia, R.

AU - Sanchez-Cabus, S.

AU - Soonawalla, Z.

AU - Abu Hilal, M.

AU - Besselink, M.G.

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

PY - 2021/12

Y1 - 2021/12

N2 - Background A radical left pancreatectomy in patients with pancreatic ductal adenocarcinoma (PDAC) may require extended, multivisceral resections. The role of a laparoscopic approach in extended radical left pancreatectomy (ERLP) is unclear since comparative studies are lacking. The aim of this study was to compare outcomes after laparoscopic vs open ERLP in patients with PDAC. Methods An international multicenter propensity-score matched study including patients who underwent either laparoscopic or open ERLP (L-ERLP; O-ERLP) for PDAC was performed (2007-2015). The ISGPS definition for extended resection was used. Primary outcomes were overall survival, margin negative rate (R0), and lymph node retrieval. Results Between 2007 and 2015, 320 patients underwent ERLP in 34 centers from 12 countries (65 L-ERLP vs. 255 O-ERLP). After propensity-score matching, 44 L-ERLP could be matched to 44 O-ERLP. In the matched cohort, the conversion rate in L-ERLP group was 35%. The L-ERLP R0 resection rate (matched cohort) was comparable to O-ERLP (67% vs 48%; P = 0.063) but the lymph node yield was lower for L-ERLP than O-ERLP (median 11 vs 19, P = 0.023). L-ERLP was associated with less delayed gastric emptying (0% vs 16%, P = 0.006) and shorter hospital stay (median 9 vs 13 days, P = 0.005), as compared to O-ERLP. Outcomes were comparable for additional organ resections, vascular resections (besides splenic vessels), Clavien-Dindo grade >= III complications, or 90-day mortality (2% vs 2%, P = 0.973). The median overall survival was comparable between both groups (19 vs 20 months, P = 0.571). Conversion did not worsen outcomes in L-ERLP. Conclusion The laparoscopic approach may be used safely in selected patients requiring ERLP for PDAC, since morbidity, mortality, and overall survival seem comparable, as compared to O-ERLP. L-ERLP is associated with a high conversion rate and reduced lymph node yield but also with less delayed gastric emptying and a shorter hospital stay, as compared to O-ERLP.

AB - Background A radical left pancreatectomy in patients with pancreatic ductal adenocarcinoma (PDAC) may require extended, multivisceral resections. The role of a laparoscopic approach in extended radical left pancreatectomy (ERLP) is unclear since comparative studies are lacking. The aim of this study was to compare outcomes after laparoscopic vs open ERLP in patients with PDAC. Methods An international multicenter propensity-score matched study including patients who underwent either laparoscopic or open ERLP (L-ERLP; O-ERLP) for PDAC was performed (2007-2015). The ISGPS definition for extended resection was used. Primary outcomes were overall survival, margin negative rate (R0), and lymph node retrieval. Results Between 2007 and 2015, 320 patients underwent ERLP in 34 centers from 12 countries (65 L-ERLP vs. 255 O-ERLP). After propensity-score matching, 44 L-ERLP could be matched to 44 O-ERLP. In the matched cohort, the conversion rate in L-ERLP group was 35%. The L-ERLP R0 resection rate (matched cohort) was comparable to O-ERLP (67% vs 48%; P = 0.063) but the lymph node yield was lower for L-ERLP than O-ERLP (median 11 vs 19, P = 0.023). L-ERLP was associated with less delayed gastric emptying (0% vs 16%, P = 0.006) and shorter hospital stay (median 9 vs 13 days, P = 0.005), as compared to O-ERLP. Outcomes were comparable for additional organ resections, vascular resections (besides splenic vessels), Clavien-Dindo grade >= III complications, or 90-day mortality (2% vs 2%, P = 0.973). The median overall survival was comparable between both groups (19 vs 20 months, P = 0.571). Conversion did not worsen outcomes in L-ERLP. Conclusion The laparoscopic approach may be used safely in selected patients requiring ERLP for PDAC, since morbidity, mortality, and overall survival seem comparable, as compared to O-ERLP. L-ERLP is associated with a high conversion rate and reduced lymph node yield but also with less delayed gastric emptying and a shorter hospital stay, as compared to O-ERLP.

KW - cancer

KW - classification

KW - cohort

KW - definition

KW - distal pancreatectomy

KW - erlp

KW - extended resection

KW - left pancreatectomy

KW - pancreatosplenectomy

KW - pdac

KW - surgery

KW - surgical complications

KW - SURGERY

KW - DEFINITION

KW - PANCREATOSPLENECTOMY

KW - CLASSIFICATION

KW - Left pancreatectomy

KW - CANCER

KW - ERLP

KW - SURGICAL COMPLICATIONS

KW - PDAC

KW - DISTAL PANCREATECTOMY

KW - COHORT

KW - Extended resection

U2 - 10.1007/s00464-020-08206-y

DO - 10.1007/s00464-020-08206-y

M3 - Article

C2 - 33398565

SN - 0930-2794

VL - 35

SP - 6949

EP - 6959

JO - Surgical endoscopy and other interventional techniques

JF - Surgical endoscopy and other interventional techniques

IS - 12

ER -