Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA)

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

doi:10.1097/SLA.0000000000002561

Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA)

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

^*Corresponding author for this work

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

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.

Original language	English
Pages (from-to)	10-17
Number of pages	8
Journal	Annals of Surgery
Volume	269
Issue number	1
DOIs	https://doi.org/10.1097/SLA.0000000000002561
Publication status	Published - Jan 2019

Keywords

distal pancreatectomy
laparoscopic
left pancreatectomy
minimally invasive
robot-assisted
INTERNATIONAL STUDY-GROUP
METAANALYSIS
SURGERY
PANCREAS
SURVIVAL
TIME
PANCREATOSPLENECTOMY
DEFINITION
STATEMENT
RESECTION

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10.1097/SLA.0000000000002561

Cite this

van Hilst, J., de Rooij, T., Klompmaker, S., Rawashdeh, M., Aleotti, F., Al-Sarireh, B., Alseidi, A., Ateeb, Z., Balzano, G., Berrevoet, F., Bjornsson, B., Boggi, U., Busch, O. R., Butturini, G., Casadei, R., Del Chiaro, M., Chikhladze, S., Cipriani, F., van Dam, R., ... Besselink, M. G. (2019). Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA). Annals of Surgery, 269(1), 10-17. https://doi.org/10.1097/SLA.0000000000002561

@article{d66f548f11c047f1be91f751ea5f859c,

title = "Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA)",

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.",

keywords = "distal pancreatectomy, laparoscopic, left pancreatectomy, minimally invasive, robot-assisted, INTERNATIONAL STUDY-GROUP, METAANALYSIS, SURGERY, PANCREAS, SURVIVAL, TIME, PANCREATOSPLENECTOMY, DEFINITION, STATEMENT, RESECTION",

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

year = "2019",

month = jan,

doi = "10.1097/SLA.0000000000002561",

language = "English",

volume = "269",

pages = "10--17",

journal = "Annals of Surgery",

issn = "0003-4932",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "1",

}

van Hilst, J, de Rooij, T, Klompmaker, S, Rawashdeh, M, Aleotti, F, Al-Sarireh, B, Alseidi, A, Ateeb, Z, Balzano, G, Berrevoet, F, Bjornsson, B, Boggi, U, Busch, OR, Butturini, G, Casadei, R, Del Chiaro, M, Chikhladze, S, Cipriani, F, van Dam, R, Damoli, I, van Dieren, S, Dokmak, S, Edwin, B, van Eijck, C, Fabre, J-M, Falconi, M, Farges, O, Fernandez-Cruz, L, Forgione, A, Frigerio, I, Fuks, D, Gavazzi, F, Gayet, B, Giardino, A, Koerkamp, BG, Hackert, T, Hassenpflug, M, Kabir, I, Keck, T, Khatkov, I, Kusar, M, Lombardo, C, Marchegiani, G, Marshall, R, Menon, KV, Montorsi, M, Orville, M, de Pastena, M, Pietrabissa, A, Poves, I, European Consortium on Minimally Invasive Pancreatic Surgery (E- MIPS), Abu Hilal, M & Besselink, MG 2019, 'Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA)', Annals of Surgery, vol. 269, no. 1, pp. 10-17. https://doi.org/10.1097/SLA.0000000000002561

TY - JOUR

T1 - Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA)

AU - van Hilst, Jony

AU - de Rooij, Thijs

AU - Klompmaker, Sjors

AU - Rawashdeh, Majd

AU - Aleotti, Francesca

AU - Al-Sarireh, Bilal

AU - Alseidi, Adnan

AU - Ateeb, Zeeshan

AU - Balzano, Gianpaolo

AU - Berrevoet, Frederik

AU - Bjornsson, Bergthor

AU - Boggi, Ugo

AU - Busch, Olivier R.

AU - Butturini, Giovanni

AU - Casadei, Riccardo

AU - Del Chiaro, Marco

AU - Chikhladze, Sophia

AU - Cipriani, Federica

AU - van Dam, Ronald

AU - Damoli, Isacco

AU - van Dieren, Susan

AU - Dokmak, Safi

AU - Edwin, Bjorn

AU - van Eijck, Casper

AU - Fabre, Jean-Marie

AU - Falconi, Massimo

AU - Farges, Olivier

AU - Fernandez-Cruz, Laureano

AU - Forgione, Antonello

AU - Frigerio, Isabella

AU - Fuks, David

AU - Gavazzi, Francesca

AU - Gayet, Brice

AU - Giardino, Alessandro

AU - Koerkamp, Bas Groot

AU - Hackert, Thilo

AU - Hassenpflug, Matthias

AU - Kabir, Irfan

AU - Keck, Tobias

AU - Khatkov, Igor

AU - Kusar, Masa

AU - Lombardo, Carlo

AU - Marchegiani, Giovanni

AU - Marshall, Ryne

AU - Menon, Krish V.

AU - Montorsi, Marco

AU - Orville, Marion

AU - de Pastena, Matteo

AU - Pietrabissa, Andrea

AU - Poves, Ignaci

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

AU - Abu Hilal, Mohammed

AU - Besselink, Marc G.

PY - 2019/1

Y1 - 2019/1

N2 - 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.

AB - 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.

KW - distal pancreatectomy

KW - laparoscopic

KW - left pancreatectomy

KW - minimally invasive

KW - robot-assisted

KW - INTERNATIONAL STUDY-GROUP

KW - METAANALYSIS

KW - SURGERY

KW - PANCREAS

KW - SURVIVAL

KW - TIME

KW - PANCREATOSPLENECTOMY

KW - DEFINITION

KW - STATEMENT

KW - RESECTION

U2 - 10.1097/SLA.0000000000002561

DO - 10.1097/SLA.0000000000002561

M3 - Article

C2 - 29099399

SN - 0003-4932

VL - 269

SP - 10

EP - 17

JO - Annals of Surgery

JF - Annals of Surgery

IS - 1

ER -