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1. Post cholecystectomy bile duct injury: early, intermediate or late repair with hepaticojejunostomy – an E-AHPBA multi-center study

Author

Rystedt, J.M.L., Kleeff, J., Salvia, R., Besselink, M.G., Prasad, R., Lesurtel, M., Sturesson, C., Abu Hilal, M., Aljaiuossi, A., Antonucci, A., Ardito, F., Ausania, F., Bernon, M., Berrevoet, F., Bjornsson, B., Bonsing, B.A., Boonstra, E.A., Bracke, B., Brusadin, R., Burda, L., Caraballo, M., Casellas-Robert, M., Coker, A., Davide, J., Gelder, A. de, Rose, A.M. de, Djokic, M., Dudek, K., Ekmekcigil, E., Filauro, M., Fulop, A., Gallagher, T.K., Gastaca, M., Gefen, R., Giuliante, F., Habibeh, H., Halle-Smith, J., Haraldsdottir, K.H., Hartman, V., Hauer, A., Hemmingsson, O., Hoskovec, D., Isaksson, B., Jonas, E., K.A., Klug, R., Krige, J., Lignier, D., Lindemann, J., Lopez-Lopez, V., Lucidi, V., Mabrut, J.Y., Mansson, C., Mieog, S., Mirza, D.F., Oldhafer, K.J., Omoshoro-Jones, J.A.O., Ortega-Torrecilla, N., Otto, W., Panaro, F., Pando, E., Paterna-Lopez, S., Pekmezci, S., Pesce, A., Porte, R.J., Poves, I., Calvo, M.P., Primavesi, F., Puleo, S., Recordare, A., Rizell, M., Roberts, K., Robles-Campos, R., Sanchiz-Cardenas, E., Sandstrom, P., Saribeyoglu, K., Schauer, M., Schreuder, M., Siriwardena, A.K., Smith, M.D., Silva, D.S., Sparrelid, E., Stattner, S., Stavrou, G.A., Straka, M., Stromberg, C., Sutcliffe, R.P., Szijarto, A., Taflin, H., Trotovsek, B., Gulik, T. van, Wallach, N., Zieniewicz, K., European-African HepatoPancreato, Skane University Hospital [Lund], Fachbereich Physik [Halle-Saale], Martin-Luther-Universität Halle Wittenberg (MLU), Azienda Ospedaliera Universitaria Integrata of Verona, University of Amsterdam [Amsterdam] (UvA), St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Karolinska University Hospital [Stockholm], University of Southampton, Policlinico di Monza, Partenaires INRAE, Universita 'La Sapienza' Roma (Istituto CNR), Università degli Studi di Roma 'La Sapienza' = Sapienza University [Rome], Catholic University, Rome, Italy, Complexo Hospitalario Universitario de Vigo, Ghent University Hospital, Linköping University (LIU), Universiteit Leiden [Leiden], University Medical Center Groningen [Groningen] (UMCG), Universiteit Antwerpen [Antwerpen], Universidad de Murcia, J. G. Mendel Cancer Center Novy Jicin, Universidad de Salamanca, Hospital Dr Josep Trueta de Girona, Izmir University, TURKEY, Faculdade de Medicina da Universidade do Porto (FMUP), Universidade do Porto, University of Ljubljana, University of Warsaw (UW), İZMİR EGE University Medical Faculty Hospital, Univeristà di Genova, Semmelweis University of Medicine [Budapest], University of Dublin, Universidad de Deusto [Bilbao] (DEUSTO), Universidad de Deusto (DEUSTO), Hospital Universitario Cruces = Cruces University Hospital, Hadassah Hebrew University Hospital, The Hebrew University of Jerusalem (HUJ), Catholic University of Rome, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Queens Elizabeth Hospital [Birmingham], University of Iceland [Reykjavik], Community Hospital of horn, Umeå University, University Hospital Motol [Prague], Uppsala Universitet [Uppsala], University of Cape Town, Hadassah Hebrew University Medical Center [Jerusalem], Community Hospital Horn, CHU Amiens-Picardie, Vrije Universiteit Brussel (VUB), Université de Lyon, Asklepios Klinik Barmbek, University of Johannesburg (UJ), Vall d'Hebron University Hospital [Barcelona], Facultad de Medicina [Zaragoza], University of Zaragoza - Universidad de Zaragoza [Zaragoza], Cerrahpasa Medical Faculty, University of Catania [Italy], IMIM-Hospital del Mar, Generalitat de Catalunya, Innsbruck Medical University [Austria] (IMU), Unité Expérimentale Recherches Intégrées - Gotheron (UERI), Institut National de la Recherche Agronomique (INRA), University of Pristina-Kosovo, Peja/Pec Hospital, Sahlgrenska Academy at University of Gothenburg [Göteborg], Universidad de Málaga [Málaga] = University of Málaga [Málaga], University Hospital Düsseldorf, Vrije Universiteit Medical Centre (VUMC), Vrije Universiteit Amsterdam [Amsterdam] (VU), Manchester Royal Infirmary, University of Manchester [Manchester], Chris Hani Baragwanath Hospital, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), European-African HepatoPancreato, Ege Üniversitesi, Groningen Institute for Organ Transplantation (GIOT), Surgery, AGEM - Digestive immunity, AGEM - Re-generation and cancer of the digestive system, CCA - Cancer Treatment and Quality of Life, and AGEM - Endocrinology, metabolism and nutrition

Subjects
INTRAOPERATIVE CHOLANGIOGRAPHY, Male, IMPACT, Settore MED/18 - CHIRURGIA GENERALE, medicine.medical_treatment, Jejunostomy, Hepatic Duct, Common, Comorbidity, 030230 surgery, 0302 clinical medicine, Cholangiography, Older patients, Hepatic Duct, Clinical endpoint, LAPAROSCOPIC CHOLECYSTECTOMY, COMPLICATIONS, OUTCOMES, medicine.diagnostic_test, Bile duct, Gastroenterology, Hepaticojejunostomy, Middle Aged, Common, 3. Good health, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Female, Adult, medicine.medical_specialty, Bile duct injuries (BDI), CLASSIFICATION, Time-to-Treatment, Biliary injury, 03 medical and health sciences, Sex Factors, HEPATIC-ARTERY INJURY, medicine, MANAGEMENT, Humans, Cholecystectomy, Aged, Retrospective Studies, Hepatology, business.industry, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, BILIARY INJURY, Surgery, Multi center study, Concomitant, RISK-FACTORS, Human medicine, Bile Ducts, business
Abstract

13th World Biennial Congress of the International-Hepato-Pancreato-Biliary-Association (IHPBA) -- SEP 04-07, 2018 -- Geneva, SWITZERLAND, Ardito, Francesco/0000-0003-1596-2862; PESCE, ANTONIO MD/0000-0002-7560-551X; Gallagher, Tom/0000-0002-5765-2574; Bernon, Marc/0000-0002-7967-8548; Stattner, Stefan/0000-0002-5226-7597; GIULIANTE, FELICE/0000-0003-2087-2589; Omoshoro-Jones, Jones A. O./0000-0002-1071-298X; de Rose, Agostino Maria/0000-0003-3310-8088; Abu Hilal, Mohammed/0000-0002-3162-4639; Kleeff, Jorg/0000-0003-3432-6669; Prieto, Mikel/0000-0001-6662-4252; Stromberg, Cecilia/0000-0003-0843-7920, WOS: 000500283700006, PubMed: 31151812, Background: Treatment of bile duct injuries (BDI) during cholecystectomy depends on the severity of injury and the timing of diagnosis. Standard of care for severe BDIs is hepaticojejunostomy. the aim of this retrospective multi-center study was to assess the optimal timing for repair of BDI with hepaticojejunostomy. Methods: Members of the European-African HepatoPancreatoBiliary Association were invited to report all consecutive patients with hepaticojejunostomy after BDI from January 2000 to June 2016. Patients were stratified according to the timing of biliary reconstruction with hepaticojejunostomy: early (day 0-7), intermediate (1-6 weeks) and late (6 weeks-6 months). Primary endpoint was re-intervention >90 days after the hepaticojejunostomy and secondary endpoints were severe 90-day complications and liver-related mortality. Results: in total 913 patients from 48 centers were included in the analysis. in 401 patients (44%) the bile duct injury was diagnosed intraoperatively, and 126 patients (14%) suffered from concomitant vascular injury. in multivariable analysis the timing of hepaticojejunostomy had no impact on postoperative complications, the need for re-intervention after 90 days nor liver-related mortality. the rate of re-intervention more than 90 days after the hepaticojejunostomy was significantly increased in male patients but decreased in older patients. Severe co-morbidity increased the risk for liver-related mortality (HR 3.439; CI 1.37-8.65; p = 0.009). Conclusion: After BDI occurring during cholecystectomy, the timing of biliary reconstruction with hepaticojejunostomy did not have any impact on severe postoperative complications, the need for re-intervention or liver-related mortality. Individualised treatment after iatrogenic bile duct injury is still advisable., Int Hepato Pancreato Biliary Assoc

Published
2019
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2. Laparoscopic versus open extended radical left pancreatectomy for pancreatic ductal adenocarcinoma: an international propensity-score matched study

Author

D. Gomez, Safi Dokmak, Frederik Berrevoet, Andrea Pietrabissa, Riccardo Casadei, Maarten Korrel, Adnan Alseidi, C. Krautz, Tobias Keck, O.R.C. Busch, A. Sa Cunha, Antonello Forgione, J. van Hilst, Bergthor Björnsson, Thilo Hackert, Ugo Boggi, A. Balduzzi, Brice Gayet, Jean-Michel Fabre, B. Groot Koerkamp, P.B. van den Boezem, Massimo Falconi, Ignasi Poves, Santiago Sánchez-Cabús, Giovanni Butturini, Ravi Marudanayagam, Zahir Soonawalla, Roberto Salvia, R. Van Dam, Mushegh A. Sahakyan, Bilal Al-Sarireh, Bjørn Edwin, S. Lof, Giorgio Ercolani, Marc G. Besselink, M. Abu Hilal, Igor Khatkov, K. Menon, Graduate School, CCA - Cancer Treatment and Quality of Life, Amsterdam Gastroenterology Endocrinology Metabolism, Surgery, 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., Falconi M., Forgione A., Gayet B., Gomez D., Koerkamp B.G., Hackert T., Keck T., Khatkov I., Krautz C., Marudanayagam R., Menon K., Pietrabissa A., Poves I., Cunha A.S., Salvia R., Sanchez-Cabus S., Soonawalla Z., Hilal M.A., Besselink M.G., RS: NUTRIM - R2 - Liver and digestive health, and MUMC+: MA Heelkunde (9)

Subjects
medicine.medical_specialty, Left pancreatectomy, ERLP, 030230 surgery, SURGICAL COMPLICATIONS, PANCREATOSPLENECTOMY, CLASSIFICATION, 03 medical and health sciences, 0302 clinical medicine, Pancreatectomy, Retrospective Studie, Internal medicine, medicine, Humans, Lymph node, Retrospective Studies, Gastric emptying, business.industry, Cancer, PDAC, cohort, Hepatology, medicine.disease, CANCER, DISTAL PANCREATECTOMY, Surgery, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Pancreatic Neoplasms, DEFINITION, medicine.anatomical_structure, Treatment Outcome, Propensity score matching, Cohort, 030211 gastroenterology & hepatology, Laparoscopy, business, Abdominal surgery, Human, Carcinoma, Pancreatic Ductal, Extended resection
Abstract

Item does not contain fulltext 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.

Published
2021

3. Minimally invasive versus open distal pancreatectomy for pancreatic ductal adenocarcinoma (DIPLOMA): study protocol for a randomized controlled trial

Author

Jony van Hilst, Maarten Korrel, Sanne Lof, Thijs de Rooij, Frederique Vissers, Bilal Al-Sarireh, Adnan Alseidi, Adrian C. Bateman, Bergthor Björnsson, Ugo Boggi, Svein Olav Bratlie, Olivier Busch, Giovanni Butturini, Riccardo Casadei, Frederike Dijk, Safi Dokmak, Bjorn Edwin, Casper van Eijck, Alessandro Esposito, Jean-Michel Fabre, Massimo Falconi, Giovanni Ferrari, David Fuks, Bas Groot Koerkamp, Thilo Hackert, Tobias Keck, Igor Khatkov, Ruben de Kleine, Arto Kokkola, David A. Kooby, Daan Lips, Misha Luyer, Ravi Marudanayagam, Krishna Menon, Quintus Molenaar, Matteo de Pastena, Andrea Pietrabissa, Rushda Rajak, Edoardo Rosso, Patricia Sanchez Velazquez, Olivier Saint Marc, Mihir Shah, Zahir Soonawalla, Ales Tomazic, Caroline Verbeke, Joanne Verheij, Steven White, Hanneke W. Wilmink, Alessandro Zerbi, Marcel G. Dijkgraaf, Marc G. Besselink, Mohammad Abu Hilal, for the European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS), van Hilst J., Korrel M., Lof S., de Rooij T., Vissers F., Al-Sarireh B., Alseidi A., Bateman A.C., Bjornsson B., Boggi U., Bratlie S.O., Busch O., Butturini G., Casadei R., Dijk F., Dokmak S., Edwin B., van Eijck C., Esposito A., Fabre J.-M., Falconi M., Ferrari G., Fuks D., Groot Koerkamp B., Hackert T., Keck T., Khatkov I., de Kleine R., Kokkola A., Kooby D.A., Lips D., Luyer M., Marudanayagam R., Menon K., Molenaar Q., de Pastena M., Pietrabissa A., Rajak R., Rosso E., Sanchez Velazquez P., Saint Marc O., Shah M., Soonawalla Z., Tomazic A., Verbeke C., Verheij J., White S., Wilmink H.W., Zerbi A., Dijkgraaf M.G., Besselink M.G., Abu Hilal M., CCA - Cancer Treatment and quality of life, Pathology, HUS Abdominal Center, II kirurgian klinikka, Surgery, Graduate School, CCA - Cancer Treatment and Quality of Life, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Anesthesiology, Oncology, Epidemiology and Data Science, and APH - Methodology

Subjects
ANTEGRADE MODULAR PANCREATOSPLENECTOMY, Medicine (General), Lymphovascular invasion, SURGERY, medicine.medical_treatment, INTERNATIONAL STUDY-GROUP, Left pancreatectomy, Distal pancreatectomy, Medicine (miscellaneous), 030230 surgery, law.invention, Pancreatic ductal adenocarcinoma, Study Protocol, 0302 clinical medicine, Postoperative Complications, Randomized controlled trial, law, Retrospective Studie, IMPLEMENTATION, Outpatient clinic, Pharmacology (medical), Lymph node, Randomized Controlled Trials as Topic, TOTAL LAPAROSCOPIC PANCREATICODUODENECTOMY, Robot-assisted, 3. Good health, medicine.anatomical_structure, Treatment Outcome, Pancreatic Ductal, 030220 oncology & carcinogenesis, Human, Carcinoma, Pancreatic Ductal, medicine.medical_specialty, RESECTION, ENHANCED RECOVERY, Splenectomy, Pancreatic surgery, CLASSIFICATION, CLINICAL-TRIAL, 03 medical and health sciences, R5-920, Laparoscopic, Pancreatectomy, Minimally invasive, Pancreatic cancer, Pancreatic tail resection, Humans, Quality of Life, Retrospective Studies, Laparoscopy, Pancreatic Neoplasms, medicine, business.industry, Kirurgi, Carcinoma, 3126 Surgery, anesthesiology, intensive care, radiology, medicine.disease, Surgery, Clinical trial, DEFINITION, Histopathology, Postoperative Complication, business
Abstract

Background Recently, the first randomized trials comparing minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) for non-malignant and malignant disease showed a 2-day reduction in time to functional recovery after MIDP. However, for pancreatic ductal adenocarcinoma (PDAC), concerns have been raised regarding the oncologic safety (i.e., radical resection, lymph node retrieval, and survival) of MIDP, as compared to ODP. Therefore, a randomized controlled trial comparing MIDP and ODP in PDAC regarding oncological safety is warranted. We hypothesize that the microscopically radical resection (R0) rate is non-inferior for MIDP, as compared to ODP. Methods/design DIPLOMA is an international randomized controlled, patient- and pathologist-blinded, non-inferiority trial performed in 38 pancreatic centers in Europe and the USA. A total of 258 patients with an indication for elective distal pancreatectomy with splenectomy because of proven or highly suspected PDAC of the pancreatic body or tail will be randomly allocated to MIDP (laparoscopic or robot-assisted) or ODP in a 1:1 ratio. The primary outcome is the microscopically radical resection margin (R0, distance tumor to pancreatic transection and posterior margin ≥ 1 mm), which is assessed using a standardized histopathology assessment protocol. The sample size is calculated with the following assumptions: 5% one-sided significance level (α), 80% power (1-β), expected R0 rate in the open group of 58%, expected R0 resection rate in the minimally invasive group of 67%, and a non-inferiority margin of 7%. Secondary outcomes include time to functional recovery, operative outcomes (e.g., blood loss, operative time, and conversion to open surgery), other histopathology findings (e.g., lymph node retrieval, perineural- and lymphovascular invasion), postoperative outcomes (e.g., clinically relevant complications, hospital stay, and administration of adjuvant treatment), time and site of disease recurrence, survival, quality of life, and costs. Follow-up will be performed at the outpatient clinic after 6, 12, 18, 24, and 36 months postoperatively. Discussion The DIPLOMA trial is designed to investigate the non-inferiority of MIDP versus ODP regarding the microscopically radical resection rate of PDAC in an international setting. Trial registration ISRCTN registry ISRCTN44897265. Prospectively registered on 16 April 2018.

Published
2021
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4. ALPPS for Locally Advanced Intrahepatic Cholangiocarcinoma: Did Aggressive Surgery Lead to the Oncological Benefit? An International Multi-center Study

Author

Ulf P. Neumann, J. Baumgart, Athanasios Petrou, Utz Settmacher, Sergey Voskanyan, M. Moustafa, Carlos Castro-Benitez, Roberto Montalti, Chao Liu, René Adam, Hans J. Schlitt, Ricardo Robles-Campos, Emilio Vicente, Yuji Soejima, E. Fasolo, Umberto Cillo, Jakub Kristek, Ivan Capobianco, Federico Tomassini, Roberto Hernandez-Alejandro, Asmus Heumann, Jakob R. Izbicki, Natascha Nuessler, Hauke Lang, Oszkár Hahn, Alexandros Kantas, Michael R. Schön, Roberto Troisi, Massimo Malagó, Silvio Nadalin, Georg Lurje, Stefan A. Topp, Michael Linecker, Enrico Gringeri, Francesca Ratti, Victoria Ardiles, Karl J. Oldhafer, Björn-Ole Stüben, Christiane Bruns, Luca Aldrighetti, Stefan M. Brunner, Henrik Petrowsky, Jun Li, Deniz Balci, Jens Rolinger, Andreas A. Schnitzbauer, Roger Wahba, Jan Bednarsch, Marco Vivarelli, Eduardo Fernandes, Pierre-Alain Clavien, Falk Rauchfuss, Jiri Fronek, Eduardo de Santibañes, Bergthor Björnsson, Li, J., Moustafa, M., Linecker, M., Lurje, G., Capobianco, I., Baumgart, J., Ratti, F., Rauchfuss, F., Balci, D., Fernandes, E., Montalti, R., Robles-Campos, R., Bjornsson, B., Topp, S. A., Fronek, J., Liu, C., Wahba, R., Bruns, C., Brunner, S. M., Schlitt, H. J., Heumann, A., Stuben, B. -O., Izbicki, J. R., Bednarsch, J., Gringeri, E., Fasolo, E., Rolinger, J., Kristek, J., Hernandez-Alejandro, R., Schnitzbauer, A., Nuessler, N., Schon, M. R., Voskanyan, S., Petrou, A. S., Hahn, O., Soejima, Y., Vicente, E., Castro-Benitez, C., Adam, R., Tomassini, F., Troisi, R. I., Kantas, A., Oldhafer, K. J., Ardiles, V., de Santibanes, E., Malago, M., Clavien, P. -A., Vivarelli, M., Settmacher, U., Aldrighetti, L., Neumann, U., Petrowsky, H., Cillo, U., Lang, H., and Nadalin, S.

Subjects
Adult, Male, medicine.medical_specialty, International Cooperation, Subgroup analysis, Antineoplastic Agents, Postoperative Hemorrhage, Malignancy, Cholangiocarcinoma, Postoperative Complications, medicine, Hepatectomy, Humans, Surgical Wound Infection, Registries, ddc:610, Stage (cooking), Risk factor, Propensity Score, Ligation, Intrahepatic Cholangiocarcinoma, Survival analysis, Aged, Proportional Hazards Models, Aged, 80 and over, business.industry, Portal Vein, Kirurgi, Palliative Care, Ascites, Middle Aged, medicine.disease, Surgery, Survival Rate, Bile Ducts, Intrahepatic, Treatment Outcome, Oncology, Bile Duct Neoplasms, Hepatobiliary Tumors, Propensity score matching, Cohort, Female, business, Liver Failure, SEER Program
Abstract

Annals of surgical oncology (2020). doi:10.1245/s10434-019-08192-z, Published by Springer, Berlin [u.a.]

Published
2020
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5. Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA): A Pan-European Propensity Score Matched Study

Author

Giovanni Butturini, Santiago Sánchez-Cabús, Igor Khatkov, Sophia Chikhladze, Susan van Dieren, John N. Primrose, Isacco Damoli, Olivier R. Busch, Marco Montorsi, Ugo Boggi, Irfan Kabir, Marco Del Chiaro, Per Sandström, Bas Groot Koerkamp, Guido A. M. Tiberio, Zahir Soonawalla, K. Menon, Andrea Pietrabissa, Robert P. Sutcliffe, Lauren Scovel, Steven A. White, Brice Gayet, Riccardo Casadei, Bergthor Björnsson, Safi Dokmak, Alessandro Zerbi, Zeeshan Ateeb, Leonardo Solaini, Ignaci Poves, Federica Cipriani, Roberto Troisi, Jean-Marie Fabre, Ales Tomazic, Massimo Falconi, Tobias Keck, Marc G. Besselink, Claudio Ricci, Claudio Bassi, Ryne Marshall, Bilal Al-Sarireh, Uwe A. Wittel, Sjors Klompmaker, Frederik Berrevoet, Marion Orville, Casper H.J. van Eijck, Matthias Hassenpflug, Antonello Forgione, Mushegh A. Sahakyan, Bjørn Edwin, Masa Kusar, Gianpaolo Balzano, F. Régis Souche, Francesca Aleotti, Bård I. Røsok, M. Rawashdeh, Francesca Gavazzi, Giovanni Marchegiani, Adnan Alseidi, Carlo Lombardo, Thijs de Rooij, David Fuks, Ulrich F. Wellner, Thilo Hackert, Olivier Farges, Mohammad Abu Hilal, Jony van Hilst, Laureano Fernández-Cruz, Ronald M. van Dam, Isabella Frigerio, Raffaele Pugliese, Keith J. Roberts, Matteo De Pastena, Alessandro Giardino, Service de chirurgie hepato-pancreato-biliaire, Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), San Raffaele Scientific Institute, Vita-Salute San Raffaele University and Center for Translational Genomics and Bioinformatics, Institut de Recherche en Cancérologie de Montpellier (IRCM - U1194 Inserm - UM), CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Van Hilst, Jony, De Rooij, Thij, Klompmaker, Sjor, 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, Matthia, Kabir, Irfan, Keck, Tobia, Khatkov, Igor, Kusar, Masa, Lombardo, Carlo, Marchegiani, Giovanni, Marshall, Ryne, Menon, Krish V, Montorsi, Marco, Orville, Marion, De Pastena, Matteo, Pietrabissa, Andrea, Poves, Ignaci, Primrose, John, Pugliese, Raffaele, Ricci, Claudio, Roberts, Keith, Røsok, Bård, Sahakyan, Mushegh A, Sánchez cabús, Santiago, Sandström, Per, Scovel, Lauren, Solaini, Leonardo, Soonawalla, Zahir, Souche, F. Régi, Sutcliffe, Robert P, Tiberio, Guido A, Tomazic, Aleš, Troisi, Roberto, Wellner, Ulrich, White, Steven, Wittel, Uwe A, Zerbi, Alessandro, Bassi, Claudio, Besselink, Marc G, Abu Hilal, Mohammed, 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., 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., Groot Koerkamp, B., Hackert, T., Hassenpflug, M., Kabir, I., Keck, T., Khatkov, I., Kusar, M., Lombardo, C., Marchegiani, G., Marshall, R., Menon, K. V., Montorsi, M., Orville, M., De Pastena, M., Pietrabissa, A., Poves, I., Primrose, J., Pugliese, R., Ricci, C., Roberts, K., Rosok, B., Sahakyan, M. A., Sanchez-Cabus, S., Sandstrom, P., Scovel, L., Solaini, L., Soonawalla, Z., Souche, F. R., Sutcliffe, R. P., Tiberio, G. A., Tomazic, A., Troisi, R., Wellner, U., White, S., Wittel, U. A., Zerbi, A., Bassi, C., Besselink, M. G., Abu Hilal, M., Graduate School, AGEM - Digestive immunity, AGEM - Endocrinology, metabolism and nutrition, AGEM - Re-generation and cancer of the digestive system, CCA - Cancer Treatment and Quality of Life, Surgery, APH - Methodology, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon, and CRLCC Val d'Aurelle - Paul Lamarque-Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, [SDV]Life Sciences [q-bio], 030230 surgery, robot-assisted, laparoscopic, distal pancreatectomy, laparoscopic, left pancreatectomy, minimally invasive, robot-assisted, 0302 clinical medicine, Postoperative Complications, Pan european, Robotic Surgical Procedures, Medicine, distal pancreatectomy, Incidence, 3. Good health, Europe, Survival Rate, medicine.anatomical_structure, left pancreatectomy, Treatment Outcome, 030220 oncology & carcinogenesis, Female, Distal pancreatectomy, Pancreas, Cohort study, Carcinoma, Pancreatic Ductal, medicine.medical_specialty, Adenocarcinoma, Article, 03 medical and health sciences, Pancreatectomy, Carcinoma, Humans, Minimally Invasive Surgical Procedures, Ductal adenocarcinoma, Propensity Score, Aged, Neoplasm Staging, Retrospective Studies, business.industry, Retrospective cohort study, Length of Stay, medicine.disease, digestive system diseases, Surgery, Pancreatic Neoplasms, Propensity score matching, minimally invasive, Pàncrees -- Càncer -- Tractament, Laparoscopy, business
Abstract

International audience; 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 \textless 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 \textgreater 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 \textless 0.001) and lymph node retrieval [14 (8-22) vs 22 (14-31), P \textless 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.

Published
2019
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