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

de Graaf, Nine ; Augustinus, Simone ; Wellner, Ulrich F ; Johansen, Karin ; Andersson, Bodil LU orcid ; Beane, Joal D ; Björnsson, Bergthor ; Busch, Olivier R ; Davis, Catherine H and Ghadimi, Michael , et al. (2024) In Surgical Endoscopy
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... (More)

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.

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epub
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Surgical Endoscopy
publisher
Springer
external identifiers
  • pmid:39342074
ISSN
0930-2794
DOI
10.1007/s00464-024-11161-7
language
English
LU publication?
yes
additional info
© 2024. The Author(s).
id
987aa55a-1081-4918-8dea-30235dd7c33c
date added to LUP
2024-09-30 12:54:05
date last changed
2024-10-02 14:17:45
@article{987aa55a-1081-4918-8dea-30235dd7c33c,
  abstract     = {{<p>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.</p><p>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 &lt; 100 MIPD were performed during the studied period.</p><p>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 &lt; 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 &lt; 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 &lt; 0.001) and OPD (2%, 5%, 3%; ALD 3%, p &lt; 0.001), similar to major morbidity; MIPD (25%, 42%, 38%, ALD 17%, p &lt; 0.001) and OPD (25%, 31%, 30%, ALD 6%, p &lt; 0.001), respectively.</p><p>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.</p>}},
  author       = {{de Graaf, Nine and Augustinus, Simone and Wellner, Ulrich F and Johansen, Karin and Andersson, Bodil and Beane, Joal D and Björnsson, Bergthor and Busch, Olivier R and Davis, Catherine H and Ghadimi, Michael and Gleeson, Elizabeth M and Groot Koerkamp, Bas and Hogg, Melissa E and van Santvoort, Hjalmar C and Tingstedt, Bobby and Uhl, Waldemar and Werner, Jens and Williamsson, Caroline and Zeh, Herbert J and Zureikat, Amer H and Abu Hilal, Mohammad and Pitt, Henry A and Besselink, Marc G.H. and Keck, Tobias}},
  issn         = {{0930-2794}},
  language     = {{eng}},
  month        = {{09}},
  publisher    = {{Springer}},
  series       = {{Surgical Endoscopy}},
  title        = {{Transatlantic differences in the use and outcome of minimally invasive pancreatoduodenectomy : an international multi-registry analysis}},
  url          = {{http://dx.doi.org/10.1007/s00464-024-11161-7}},
  doi          = {{10.1007/s00464-024-11161-7}},
  year         = {{2024}},
}