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

A Balduzzi; J van Hilst; M Korrel; S Lof; B Al-Sarireh; A Alseidi; F Berrevoet; B Björnsson; P van den Boezem; U Boggi; O R Busch; G Butturini; R Casadei; R van Dam; S Dokmak; B Edwin; M A Sahakyan; G Ercolani; J M Fabre; M Falconi; A Forgione; B Gayet; D Gomez; B Groot Koerkamp; T Hackert; T Keck; I Khatkov; C Krautz; R Marudanayagam; K Menon; A Pietrabissa; I Poves; A Sa Cunha; R Salvia; S Sánchez-Cabús; Z Soonawalla; M Abu Hilal; M G Besselink; European Consortium on Minimally Invasive Pancreatic Surgery (E- MIPS)

doi:10.1007/s00464-020-08206-y

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

Surg Endosc. 2021 Dec;35(12):6949-6959. doi: 10.1007/s00464-020-08206-y. Epub 2021 Jan 4.

Authors

A Balduzzi^#^{1

2}, J van Hilst^#³, M Korrel³, S Lof^{3

4}, B Al-Sarireh⁵, A Alseidi⁶, F Berrevoet⁷, B Björnsson⁸, P van den Boezem⁹, U Boggi¹⁰, O R Busch³, G Butturini¹¹, R Casadei¹², R van Dam^{13

14}, S Dokmak¹⁵, B Edwin¹⁶, M A Sahakyan^{16

17}, G Ercolani^{18

19}, J M Fabre²⁰, M Falconi²¹, A Forgione²², B Gayet²³, D Gomez²⁴, B Groot Koerkamp²⁵, T Hackert²⁶, T Keck²⁷, I Khatkov²⁸, C Krautz²⁹, R Marudanayagam³⁰, K Menon³¹, A Pietrabissa³², I Poves³³, A Sa Cunha³⁴, R Salvia³⁵, S Sánchez-Cabús³⁶, Z Soonawalla³⁷, M Abu Hilal^{38

39

40}, M G Besselink⁴¹; European Consortium on Minimally Invasive Pancreatic Surgery (E- MIPS)

Affiliations

¹ Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands. [email protected].
² General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. [email protected].
³ Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands.
⁴ Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁵ Department of Surgery, Morriston Hospital, Swansea, UK.
⁶ Department of Surgery, Virginia Mason Medical Center, Seattle, USA.
⁷ Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium.
⁸ Department of Surgery in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
⁹ Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
¹⁰ Department of Surgery, Universitá di Pisa, Pisa, Italy.
¹¹ Department of Surgery, Pederzoli Hospital, Peschiera, Italy.
¹² Department of Surgery, S. Orsola-Malpighi Hospital, Bologna, Italy.
¹³ Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
¹⁴ Department of Surgery, University Hospital RWTH Aachen, Aachen, Germany.
¹⁵ Department of Surgery, Hospital of Beaujon, Clichy, France.
¹⁶ Department of Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway.
¹⁷ Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia.
¹⁸ Department of General Surgery and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna Forlì, Forlì, Italy.
¹⁹ Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
²⁰ Department of Surgery, Hopital Saint Eloi, Montpellier, France.
²¹ San Raffaele Hospital Pancreas Translational & Clinical Research Center, San Raffaele Hospital, Università Vita-Salute, Milan, Italy.
²² Department of Surgery, Niguarda Ca' Granda Hospital, Milan, Italy.
²³ Department of Surgery, Institut Mutualiste Montsouris, Paris, France.
²⁴ Department of Surgery, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK.
²⁵ Department of Surgery, Erasmus MC, Rotterdam, The Netherlands.
²⁶ Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany.
²⁷ Department of Surgery, University Hospital Schleswig-Holstein UKSH Campus Lübeck, Lübeck, Germany.
²⁸ Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russian Federation.
²⁹ Department of Surgery, University Hospital Erlangen, Erlangen, Germany.
³⁰ Department of Surgery, University Hospital Birmingham, Birmingham, UK.
³¹ Department of Surgery, King's College Hospital NHS Foundation Trust, London, UK.
³² Department of Surgery, University Hospital Pavia, Pavia, Italy.
³³ Department of Surgery, Hospital del Mar, Barcelona, Spain.
³⁴ Department of Surgery, Hôpital Paul-Brousse, Villejuif, France.
³⁵ General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
³⁶ Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain.
³⁷ Department of Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK.
³⁸ Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK. [email protected].
³⁹ Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy. [email protected].
⁴⁰ HPB and Minimally Invasive Surgery, Southampton University, Southampton, UK. [email protected].
⁴¹ Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands. [email protected].

^# Contributed equally.

PMID: 33398565
DOI: 10.1007/s00464-020-08206-y

Abstract

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.

Keywords: ERLP; Extended resection; Left pancreatectomy; PDAC.

Publication types

Multicenter Study

MeSH terms

Carcinoma, Pancreatic Ductal* / surgery
Humans
Laparoscopy*
Pancreatectomy
Pancreatic Neoplasms* / surgery
Retrospective Studies
Treatment Outcome