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

Autor:	van Hilst J; Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands., de Rooij T; Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands., Klompmaker S; Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands., Rawashdeh M; Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom., Aleotti F; Department of Surgery, San Raffaele Hospital, Milan, Italy., Al-Sarireh B; Department of Surgery, Morriston Hospital, Swansea, United Kingdom., Alseidi A; Department of Surgery, Virginia Mason Medical Center, Seattle, United States., Ateeb Z; Department of Surgery, Karolinska Institute, Stockholm, Sweden., Balzano G; Department of Surgery, San Raffaele Hospital, Milan, Italy., Berrevoet F; Department of General and HPB surgery and liver transplantation, Ghent University Hospital, Ghent, Belgium., Björnsson B; Department of Surgery, Linköping University, Linköping, Sweden., Boggi U; Department of Surgery, Universitá di Pisa, Pisa, Italy., Busch OR; Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands., Butturini G; Department of Surgery, Pederzoli Hospital, Peschiera, Italy., Casadei R; Department of Surgery, S. Orsola-Malpighi Hospital, Bologna, Italy., Del Chiaro M; Department of Surgery, Karolinska Institute, Stockholm, Sweden., Chikhladze S; Department of Surgery, Universitätsklinikum Freiburg, Freiburg, Germany., Cipriani F; Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom., van Dam R; Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands., Damoli I; Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy., van Dieren S; Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands., Dokmak S; Department of Surgery, Hospital of Beaujon, Clichy, France., Edwin B; Department of Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway., van Eijck C; Department of Surgery, Erasmus MC, Rotterdam, the Netherlands., Fabre JM; Department of Surgery, Hopital Saint Eloi, Montpellier, France., Falconi M; Department of Surgery, San Raffaele Hospital, Milan, Italy., Farges O; Department of Surgery, Hospital of Beaujon, Clichy, France., Fernández-Cruz L; Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain., Forgione A; Department of Surgery, Niguarda Ca' Granda Hospital, Milan, Italy., Frigerio I; Department of Surgery, Pederzoli Hospital, Peschiera, Italy., Fuks D; Department of Surgery, Institut Mutualiste Montsouris, Paris, France., Gavazzi F; Department of Surgery, Humanitas University Hospital, Milan, Italy., Gayet B; Department of Surgery, Institut Mutualiste Montsouris, Paris, France., Giardino A; Department of Surgery, Pederzoli Hospital, Peschiera, Italy., Groot Koerkamp B; Department of Surgery, Erasmus MC, Rotterdam, the Netherlands., Hackert T; Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany., Hassenpflug M; Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany., Kabir I; Department of Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom., Keck T; Clinic for Surgery, UKSH Campus Lübeck, Lübeck, Germany., Khatkov I; Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russian Federation., Kusar M; Department of Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia., Lombardo C; Department of Surgery, Universitá di Pisa, Pisa, Italy., Marchegiani G; Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy., Marshall R; Department of Surgery, Virginia Mason Medical Center, Seattle, United States., Menon KV; Department of Surgery, King's College Hospital NHS Foundation Trust, London, United Kingdom., Montorsi M; Department of Surgery, Humanitas University Hospital, Milan, Italy., Orville M; Department of Surgery, Hospital of Beaujon, Clichy, France., de Pastena M; Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy., Pietrabissa A; Department of Surgery, University hospital Pavia, Pavia, Italy., Poves I; Department of Surgery, Hospital del Mar, Barcelona, Spain., Primrose J; Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom., Pugliese R; Department of Surgery, Niguarda Ca' Granda Hospital, Milan, Italy., Ricci C; Department of Surgery, S. Orsola-Malpighi Hospital, Bologna, Italy., Roberts K; Department of Surgery, University Hospital Birmingham, Birmingham, United Kingdom., Røsok B; Department of Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway., Sahakyan MA; Department of Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway., Sánchez-Cabús S; Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain., Sandström P; Department of Surgery, Linköping University, Linköping, Sweden., Scovel L; Department of Surgery, Virginia Mason Medical Center, Seattle, United States., Solaini L; Surgical Clinic, Department of clinical and experimental sciences, University of Brescia, Brescia, Italy., Soonawalla Z; Department of Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom., Souche FR; Department of Surgery, Hopital Saint Eloi, Montpellier, France., Sutcliffe RP; Department of Surgery, University Hospital Birmingham, Birmingham, United Kingdom., Tiberio GA; Surgical Clinic, Department of clinical and experimental sciences, University of Brescia, Brescia, Italy., Tomazic A; Department of Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia., Troisi R; Department of General and HPB surgery and liver transplantation, Ghent University Hospital, Ghent, Belgium., Wellner U; Clinic for Surgery, UKSH Campus Lübeck, Lübeck, Germany., White S; Department of Surgery, The Freeman Hospital Newcastle Upon Tyne, Newcastle, United Kingdom., Wittel UA; Department of Surgery, Universitätsklinikum Freiburg, Freiburg, Germany., Zerbi A; Department of Surgery, Humanitas University Hospital, Milan, Italy., Bassi C; Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy., Besselink MG; Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands., Abu Hilal M; Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2019 Jan; Vol. 269 (1), pp. 10-17.
DOI:	10.1097/SLA.0000000000002561
Abstrakt:	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.
Databáze:	MEDLINE
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