Outcomes After Minimally-invasive Versus Open Pancreatoduodenectomy

作者：Sjors Klompmaker, Jony van Hilst, Ulrich Friedrich Wellner, Olivier R. Busch, Andrea Coratti, Mathieu André D’Hondt, Safi Dokmak, Sebastiaan Festen, Mustafa Kerem, Igor E Khatkov, Daan J. Lips, Carlo Lombardo, Misha D. P. Luyer, Alberto Manzoni, Izaäk Q. Molenaar, Edoardo Rosso, Olivier Saint‐Marc, Franky Vansteenkiste, Uwe A. Wittel, Bert A. Bonsing, Bas Groot Koerkamp, Mohammad Abu Hilal, David Fuks, Ignasi Poves, Tobias Keck, Ugo Boggi, Marc G. Besselink · 发表于：Annals of Surgery · 年份：2018 · DOI：10.1097/sla.0000000000002850 · 被引用次数：161 · 研究领域：Pancreatic and Hepatic Oncology Research、Cholangiocarcinoma and Gallbladder Cancer Studies、Gallbladder and Bile Duct Disorders

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 morbidi...