Outcome of Minimally Invasive and Open Pancreatoduodenectomy in Patients with Intestinal- and Pancreatobiliary Subtype Ampullary Cancer: An International Multicenter Cohort Study

Bas A Uijterwijk; Alma Moekotte; Ugo Boggi; Michele Mazzola; Bas Groot Koerkamp; Raffaele Dalla Valle; Alessandro Mazzotta; Misha Luyer; Geert Kazemier; Benedetto Ielpo; Miguel Angel Suarez Muñoz; Louisa Bolm; Bergthor Björnsson; Patrick Pessaux; Jorg Kleeff; Giuseppe Kito Fusai; Ernesto Sparrelid; Alessandro Zerbi; Daniël H Lemmers; Adnan Alseidi; Miljana Vladimirov; Keith J Roberts; Roberto Salvia; Zahir Soonawalla; Dimitris Korkolis; Mario Serradilla-Martín; Vasileios K Mavroeidis; Stefan A W Bouwense; Marc G Besselink; Mohammed Abu Hilal; International Study Group on non-pancreatic periampullary Cancer (ISGACA)

doi:10.1097/SLA.0000000000006515

Outcome of Minimally Invasive and Open Pancreatoduodenectomy in Patients with Intestinal- and Pancreatobiliary Subtype Ampullary Cancer: An International Multicenter Cohort Study

Ann Surg. 2024 Sep 2. doi: 10.1097/SLA.0000000000006515. Online ahead of print.

Authors

Bas A Uijterwijk^{1

2

3}, Alma Moekotte^{2

3}, Ugo Boggi⁴, Michele Mazzola⁵, Bas Groot Koerkamp⁶, Raffaele Dalla Valle⁷, Alessandro Mazzotta⁸, Misha Luyer⁹, Geert Kazemier¹⁰, Benedetto Ielpo¹¹, Miguel Angel Suarez Muñoz¹², Louisa Bolm¹³, Bergthor Björnsson¹⁴, Patrick Pessaux¹⁵, Jorg Kleeff¹⁶, Giuseppe Kito Fusai¹⁷, Ernesto Sparrelid¹⁸, Alessandro Zerbi¹⁹, Daniël H Lemmers^{1

2

3}, Adnan Alseidi²⁰, Miljana Vladimirov^{20

21}, Keith J Roberts²², Roberto Salvia²³, Zahir Soonawalla²⁴, Dimitris Korkolis²⁵, Mario Serradilla-Martín²⁶, Vasileios K Mavroeidis^{24

27}, Stefan A W Bouwense²⁸, Marc G Besselink², Mohammed Abu Hilal^{1

29}; International Study Group on non-pancreatic periampullary Cancer (ISGACA)

Collaborators

International Study Group on non-pancreatic periampullary Cancer (ISGACA):
Laurence Webber, Ulrich Wellner, Mark Ramaekers, Poya Ghorbani, Giuseppe Malleo, Gennaro Nappo, James Halle-Smith, Anouk de Wilde, Judith de Vos Geelen, Karin Johansen, Tara S Kent, Alessandro Giani

Affiliations

¹ Department of Surgery, Fondazione Poliambulanza, Brescia, Italy.
² Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.
³ Cancer Center Amsterdam, Amsterdam, the Netherlands.
⁴ Department of Surgery, Pisa University Hospital, Pisa, Italy.
⁵ Division of Oncologic and Mini-invasive General Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
⁶ Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
⁷ University Hospital of Parma, Department of Surgery, Parma, Italy.
⁸ Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France.
⁹ Catharina Hospital Eindhoven, Department of Surgery, Netherlands.
¹⁰ Department of Surgery, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands.
¹¹ Department of Surgery, Hospital del Mar, Barcelona, Spain.
¹² University Hospital Virgen de la Victoria, Malaga, Spain.
¹³ Department of Surgery, University Medical Center Schleswig-Holstein, campus Lübeck, Germany.
¹⁴ Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
¹⁵ Hepatobiliary and Pancreatic Surgical Unit, Nouvel Hôpital Civil (NHC), Strasbourg, France.
¹⁶ Department of Surgery, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany.
¹⁷ Department of Surgery, Royal Free London NHS Foundation Trust, London, UK.
¹⁸ Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
¹⁹ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy" and "Pancreatic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Italy.
²⁰ Department of General Surgery, Paracelsus Medical University Nürnberg, 90419 Nürnberg, Germany.
²¹ Department of Abdominal Surgery, University Hospital Lippe, University Bielefeld, Campus Detmold.
²² Faculty of medicine, University of Birmingham, Birmingham, UK.
²³ Department of General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
²⁴ Department of Hepatobiliary and Pancreatic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
²⁵ Hellenic Anticancer Hospital 'Saint Savvas', Athens, Greece.
²⁶ Instituto de Investigación Sanitaria Aragón, Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain.
²⁷ Department of Academic Surgery, The Royal Marsden Hospital, London, UK.
²⁸ Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands.
²⁹ Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.

PMID: 39219532
DOI: 10.1097/SLA.0000000000006515

Abstract

Objective: To compare minimally invasive and open pancreatoduodenectomy in different subtypes of ampullary adenocarcinoma.

Summary background data: Ampullary adenocarcinoma (AAC) is widely seen as the best indication for minimally invasive pancreatoduodenectomy (MIPD) due to the lack of vascular involvement and dilated bile and pancreatic duct. However, it is unknown whether outcomes of MIPD for AAC differ between the pancreatobiliary (AAC-PB) and intestinal (AAC-IT) subtypes as large studies are lacking.

Methods: This is an international cohort study, encompassing 27 centers from 12 countries. Outcome of MIPD and open pancreatoduodenectomy (OPD) were compared in patients with AAC-IT and AAC-PB. Primary end points were R1 rate, lymph node yield, and 5-year overall survival (5yOS).

Results: Overall, 1187 patients after MIPD for AAC were included, of whom 572 with AAC-IT (62 MIPD, 510 OPD) and 615 with AAC-PB (41 MIPD and 574 OPD). The rate of R1 resection was not significantly different between MIPD and OPD for both AAC-IT (3.4% vs 6.9%, P=0,425) and AAC-PB (9.8% vs 14.9%, P=0,625). AAC-IT, more lymph nodes were resected with MIPD group (19 vs 16, P=0.007), compared to OPD. The 5y-OS did not differ after MIPD and OPD for both AAC-IT (56.8% vs 59.5%, P=0.827 and AAC-PB (52.5% vs 44.4%, P=0.357). The rates of surgical complication between MIPD and OPD did not differ between AmpIT and AmpPB.

Discussion: This international multicenter study found no differences in outcomes between MIPD and OPD for AAC-IT and AAC-PB. MIPD and OPD demonstrated comparable outcomes in oncological resection, survival and surgical outcomes for both subtypes of AAC.