International differences in the selection and outcome of minimally invasive and open distal pancreatectomy : A transatlantic analysis
(2024) In Surgery 176(4). p.1198-1206- Abstract
BACKGROUND: The efficacy and safety of minimally invasive distal pancreatectomy have been confirmed by randomized trials, but current patient selection and outcome of minimally invasive distal pancreatectomy in large international cohorts is unknown. This study aimed to compare the use and outcome of minimally invasive distal pancreatectomy in North America, the Netherlands, Germany, and Sweden.
METHODS: All patients in the 4 Global Audits on Pancreatic Surgery Group (GAPASURG) registries who underwent minimally invasive distal pancreatectomy or open distal pancreatectomy during 2014-2020 were included.
RESULTS: Overall, 20,158 distal pancreatectomies were included, of which 7,316 (36%) were minimally invasive distal... (More)
BACKGROUND: The efficacy and safety of minimally invasive distal pancreatectomy have been confirmed by randomized trials, but current patient selection and outcome of minimally invasive distal pancreatectomy in large international cohorts is unknown. This study aimed to compare the use and outcome of minimally invasive distal pancreatectomy in North America, the Netherlands, Germany, and Sweden.
METHODS: All patients in the 4 Global Audits on Pancreatic Surgery Group (GAPASURG) registries who underwent minimally invasive distal pancreatectomy or open distal pancreatectomy during 2014-2020 were included.
RESULTS: Overall, 20,158 distal pancreatectomies were included, of which 7,316 (36%) were minimally invasive distal pancreatectomies. Use of minimally invasive distal pancreatectomy varied from 29% to 54% among registries, of which 13% to 35% were performed robotically. Both the use of minimally invasive distal pancreatectomy and robotic surgery were the highest in the Netherlands. Patients undergoing minimally invasive distal pancreatectomy tended to have a younger age (Germany and Sweden), female sex (North America, Germany), higher body mass index (North America, the Netherlands, Germany), lower comorbidity classification (North America, Germany, Sweden), lower performance status (Germany), and lower rate of pancreatic adenocarcinoma (all). The minimally invasive distal pancreatectomy group had fewer vascular resections (all) and lower rates of severe complications and mortality (North America, Germany). In the multivariable regression analysis, country was associated with severe complications but not with 30-day mortality. Minimally invasive distal pancreatectomy was associated with a lower risk of 30-day mortality compared with open distal pancreatectomy (odds ratio 1.633, 95% CI 1.159-2.300, P = .005).
CONCLUSIONS: Considerable disparities were seen in the use of minimally invasive distal pancreatectomy among 4 transatlantic registries of pancreatic surgery. Overall, minimally invasive distal pancreatectomy was associated with decreased mortality as compared with open distal pancreatectomy. Differences in patient selection among countries could imply that countries are in different stages of the learning curve.
(Less)
- author
- author collaboration
- organization
- publishing date
- 2024-10
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Humans, Pancreatectomy/methods, Female, Male, Middle Aged, Aged, Robotic Surgical Procedures/statistics & numerical data, Patient Selection, Minimally Invasive Surgical Procedures/methods, Registries/statistics & numerical data, Pancreatic Neoplasms/surgery, Sweden/epidemiology, Netherlands/epidemiology, Treatment Outcome, Postoperative Complications/epidemiology, Adult, Germany/epidemiology, North America/epidemiology
- in
- Surgery
- volume
- 176
- issue
- 4
- pages
- 1198 - 1206
- publisher
- Elsevier
- external identifiers
-
- scopus:85198724589
- pmid:39019733
- ISSN
- 1532-7361
- DOI
- 10.1016/j.surg.2024.06.028
- language
- English
- LU publication?
- yes
- additional info
- Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.
- id
- 2e6524ea-d9d3-4623-bacf-5948e4c1a4ca
- date added to LUP
- 2024-09-30 12:59:46
- date last changed
- 2024-10-02 14:17:45
@article{2e6524ea-d9d3-4623-bacf-5948e4c1a4ca, abstract = {{<p>BACKGROUND: The efficacy and safety of minimally invasive distal pancreatectomy have been confirmed by randomized trials, but current patient selection and outcome of minimally invasive distal pancreatectomy in large international cohorts is unknown. This study aimed to compare the use and outcome of minimally invasive distal pancreatectomy in North America, the Netherlands, Germany, and Sweden.</p><p>METHODS: All patients in the 4 Global Audits on Pancreatic Surgery Group (GAPASURG) registries who underwent minimally invasive distal pancreatectomy or open distal pancreatectomy during 2014-2020 were included.</p><p>RESULTS: Overall, 20,158 distal pancreatectomies were included, of which 7,316 (36%) were minimally invasive distal pancreatectomies. Use of minimally invasive distal pancreatectomy varied from 29% to 54% among registries, of which 13% to 35% were performed robotically. Both the use of minimally invasive distal pancreatectomy and robotic surgery were the highest in the Netherlands. Patients undergoing minimally invasive distal pancreatectomy tended to have a younger age (Germany and Sweden), female sex (North America, Germany), higher body mass index (North America, the Netherlands, Germany), lower comorbidity classification (North America, Germany, Sweden), lower performance status (Germany), and lower rate of pancreatic adenocarcinoma (all). The minimally invasive distal pancreatectomy group had fewer vascular resections (all) and lower rates of severe complications and mortality (North America, Germany). In the multivariable regression analysis, country was associated with severe complications but not with 30-day mortality. Minimally invasive distal pancreatectomy was associated with a lower risk of 30-day mortality compared with open distal pancreatectomy (odds ratio 1.633, 95% CI 1.159-2.300, P = .005).</p><p>CONCLUSIONS: Considerable disparities were seen in the use of minimally invasive distal pancreatectomy among 4 transatlantic registries of pancreatic surgery. Overall, minimally invasive distal pancreatectomy was associated with decreased mortality as compared with open distal pancreatectomy. Differences in patient selection among countries could imply that countries are in different stages of the learning curve.</p>}}, author = {{Johansen, Karin U and Augustinus, Simone and Wellner, Ulrich F 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 de Graaf, Nine and Koerkamp, Bas Groot and Pitt, Henry A and van Santvoort, Hjalmar C and Tingstedt, Bobby and Uhl, Waldemar and Werner, Jens and Williamsson, Caroline and Besselink, Marc G.H. and Keck, Tobias}}, issn = {{1532-7361}}, keywords = {{Humans; Pancreatectomy/methods; Female; Male; Middle Aged; Aged; Robotic Surgical Procedures/statistics & numerical data; Patient Selection; Minimally Invasive Surgical Procedures/methods; Registries/statistics & numerical data; Pancreatic Neoplasms/surgery; Sweden/epidemiology; Netherlands/epidemiology; Treatment Outcome; Postoperative Complications/epidemiology; Adult; Germany/epidemiology; North America/epidemiology}}, language = {{eng}}, number = {{4}}, pages = {{1198--1206}}, publisher = {{Elsevier}}, series = {{Surgery}}, title = {{International differences in the selection and outcome of minimally invasive and open distal pancreatectomy : A transatlantic analysis}}, url = {{http://dx.doi.org/10.1016/j.surg.2024.06.028}}, doi = {{10.1016/j.surg.2024.06.028}}, volume = {{176}}, year = {{2024}}, }