Oncological resection and perioperative outcomes of robotic, laparoscopic and open pancreatoduodenectomy for ampullary adenocarcinoma: a propensity score matched international multicenter cohort study.
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Uijterwijk Bas A, Moekotte Alma, Boggi Ugo, Mazzola Michele, Groot Koerkamp Bas, Dalle Valle Raffaele, Koek Sharnice, Bolm Louisa, Mazzotta Alessandro, Luyer Misha, Goh Brian K P, Suarez Muñoz Miguel A, Björnsson Bergthor, Kazemier Geert, Ielpo Benedetto, Pessaux Patrick, Kleeff Jorg, Ghorbani Poya, Mavroeidis Vasileios K, Fusai Giuseppe K, Salvia Roberto, Zerbi Alessandro, Roberts Keith J, Alseidi Adnan, Al-Sarireh Bilal, Serradilla-Martín Mario, Vladimirov Miljana, Korkolis Dimitris, Soonawalla Zahir, Gruppo Mario, Bouwense Stefan A W, Vollmer Charles M, Behrman Stephen W, Christein John D, Besselink Marc G, Abu Hilal Mohammed, International Study Group on non-pancreatic periampullary Cancer (ISGACA)
Аннотация
METHODS: In this multicenter international cohort study, encompassing 35 centers from 11 countries, MIPD versus OPD and subgroup analyses of LPD versus RPD were undertaken. The primary outcomes regarded the oncological resection (R1 resection rate, lymph node yield) and 5-years overall survival. Secondary outcomes were perioperative outcomes (including intra-operative variables, surgical complications and hospital stay).
RESULTS: In total, patients with AAC who underwent OPD (1721) or MIPD (141) were included. After propensity-score matching, 134 patients per cohort were included. The MIPD group consisted of 53 RPDs and 71 LPDs (50 per group after PSM). There was no difference in overall survival between MIPD and OPD (61.6 % vs 56.2 %, P = 0.215). In the MIPD group, operative time was longer (439 vs 360 min, P < 0.001). Between RPD and LPD, overall survival was not significantly different (75.8 % vs 47.4 %, P = 0.098) and lymph node yield was higher in RPD (21 vs 18, P = 0.014).
CONCLUSION: In conclusion, patients with AAC seem to have comparable oncological resection and perioperative outcomes from MIPD compared to the traditional OPD. Both RPD as LPD appear to be safe alternatives for patients with AAC, which warrants confirmation by future randomized studies.