Transatlantic differences in the use and outcome of minimally invasive pancreatoduodenectomy: an international multi-registry analysis

Nine de Graaf; Simone Augustinus; Ulrich F Wellner; Karin Johansen; Bodil Andersson; Joal D Beane; Bergthor Björnsson; Olivier R Busch; Catherine H Davis; Michael Ghadimi; Elizabeth M Gleeson; Bas Groot Koerkamp; Melissa E Hogg; Hjalmar C van Santvoort; Bobby Tingstedt; Waldemar Uhl; Jens Werner; Caroline Williamsson; Herbert J Zeh; Amer H Zureikat; Mohammad Abu Hilal; Henry A Pitt; Marc G Besselink; Tobias Keck; Global Audits on Pancreatic Surgery Group (GAPASURG)

doi:10.1007/s00464-024-11161-7

Transatlantic differences in the use and outcome of minimally invasive pancreatoduodenectomy: an international multi-registry analysis

Surg Endosc. 2024 Sep 28. doi: 10.1007/s00464-024-11161-7. Online ahead of print.

Authors

Nine de Graaf^#^{1

2}, Simone Augustinus^#^{3

1}, Ulrich F Wellner⁴, Karin Johansen⁵, Bodil Andersson⁶, Joal D Beane⁷, Bergthor Björnsson⁵, Olivier R Busch^{3

1}, Catherine H Davis⁸, Michael Ghadimi⁹, Elizabeth M Gleeson¹⁰, Bas Groot Koerkamp¹¹, Melissa E Hogg¹², Hjalmar C van Santvoort¹³, Bobby Tingstedt⁶, Waldemar Uhl¹⁴, Jens Werner¹⁵, Caroline Williamsson⁶, Herbert J Zeh¹⁶, Amer H Zureikat¹⁷, Mohammad Abu Hilal², Henry A Pitt^#⁸, Marc G Besselink^#^{18

19

20}, Tobias Keck^#^{21

22}; Global Audits on Pancreatic Surgery Group (GAPASURG)

Affiliations

¹ Cancer Center Amsterdam, Amsterdam, the Netherlands.
² Fondazione Poliabulanza Istituto Ospedaliero, Brescia, Italy.
³ Department of Surgery Amsterdam, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands.
⁴ DGAV StuDoQ|Pancreas and Clinic of Surgery, UKSH Campus Lübeck, Lübeck, Germany.
⁵ Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
⁶ Department of Clinical Sciences Lund, Surgery, Lund University and Skåne University Hospital, Lund, Sweden.
⁷ Department of Surgery, The Ohio State University, Columbus, OH, USA.
⁸ Department of Surgery, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
⁹ Department of Surgery, University Medical Centre Göttingen, Göttingen, the Netherlands.
¹⁰ Department of Surgery, Mount Sinai Hospital, New York, NY, USA.
¹¹ Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
¹² Department of Surgery, Northshore University HealthSystem, Evanston, IL, USA.
¹³ Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht and St. Antonius Hospital Nieuwegein, Utrecht, the Netherlands.
¹⁴ Department of Surgery, St. Josef-Hospital Bochum, Bochum, Germany.
¹⁵ Department of Surgery, Ludwig-Maximilians-Universität, Munich, Germany.
¹⁶ Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁷ Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA.
¹⁸ Department of Surgery Amsterdam, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands. [email protected].
¹⁹ Cancer Center Amsterdam, Amsterdam, the Netherlands. [email protected].
²⁰ Department of Surgery Amsterdam, Amsterdam UMC, Location University of Amsterdam, De Boelelaan 1117 (ZH-7F), 1081 HV, Amsterdam, the Netherlands. [email protected].
²¹ DGAV StuDoQ|Pancreas and Clinic of Surgery, UKSH Campus Lübeck, Lübeck, Germany. [email protected].
²² Department of Surgery, UKSH Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany. [email protected].

^# Contributed equally.

PMID: 39342074
DOI: 10.1007/s00464-024-11161-7

Abstract

Background: Minimally invasive pancreatoduodenectomy (MIPD) has emerged as an alternative to open pancreatoduodenectomy (OPD). However, the extent of variation in the use and outcomes of MIPD in relation to OPD among countries is unclear as international studies using registry data are lacking. This study aimed to investigate the use, patient selection, and outcomes of MIPD and OPD in four transatlantic audits for pancreatic surgery.

Methods: A post hoc comparative analysis including consecutive patients after MIPD and OPD from four nationwide and multicenter pancreatic surgery audits from North America, Germany, the Netherlands, and Sweden (2014-2020). Patient factors related to MIPD were identified using multivariable logistic regression. Outcome analyses excluded the Swedish audit because < 100 MIPD were performed during the studied period.

Results: Overall, 44,076 patients who underwent pancreatoduodenectomy were included (29,107 North America, 7586 Germany, 4970 the Netherlands, and 2413 Sweden), including 3328 MIPD procedures (8%). The use of MIPD varied widely among countries (absolute largest difference [ALD] 17%, p < 0.001): 7% North America, 4% Germany, 17% the Netherlands, and 0.1% Sweden. Over time, the use of MIPD increased in North America and the Netherlands (p < 0.001), mostly driven by robotic MIPD, but not in Germany (p = 0.297). Patient factors predicting the use of MIPD included country, later year of operation, better performance status, high POPF-risk score, no vascular resection, and non-malignant indication. Conversion rates were higher in laparoscopic MIPD (range 28-45%), compared to robotic MIPD (range 9-37%). In-hospital/30-day mortality differed among North America, Germany, and the Netherlands; MIPD (2%, 7%, 4%; ALD 5%, p < 0.001) and OPD (2%, 5%, 3%; ALD 3%, p < 0.001), similar to major morbidity; MIPD (25%, 42%, 38%, ALD 17%, p < 0.001) and OPD (25%, 31%, 30%, ALD 6%, p < 0.001), respectively.

Conclusions: Considerable differences were found in the use and outcome, including conversion and mortality rates, of MIPD and OPD among four transatlantic audits for pancreatic surgery. Our findings highlight the need for international collaboration to optimize treatment standards and patient outcome.

Keywords: Laparoscopy; Minimally invasive surgery; Pancreatic cancer; Robot-assisted; Robotic; Whipple; pancreatoduodenectomy.