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International differences in the selection and outcome of minimally invasive and open distal pancreatectomy : A transatlantic analysis

Johansen, Karin U ; Augustinus, Simone ; Wellner, Ulrich F ; Andersson, Bodil LU orcid ; Beane, Joal D ; Björnsson, Bergthor ; Busch, Olivier R ; Davis, Catherine H ; Ghadimi, Michael and Gleeson, Elizabeth M , et al. (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.

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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}},
}