Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Sweden.
Department of Surgery, Amsterdam UMC, Location University of Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands.
Surgery. 2024 Oct;176(4):1198-1206. doi: 10.1016/j.surg.2024.06.028. Epub 2024 Jul 16.
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.
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.
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).
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.
微创远端胰腺切除术的疗效和安全性已通过随机试验得到证实，但目前尚不清楚大型国际队列中微创远端胰腺切除术的患者选择和结果。本研究旨在比较北美、荷兰、德国和瑞典四个全球胰腺手术审计 (GAPASURG) 登记处微创远端胰腺切除术的使用情况和结果。
所有在 2014 年至 2020 年期间接受微创远端胰腺切除术或开放远端胰腺切除术的 GAPASURG 登记处患者均纳入本研究。
总体而言，共纳入 20158 例远端胰腺切除术，其中 7316 例（36%）为微创远端胰腺切除术。各登记处微创远端胰腺切除术的使用率从 29%到 54%不等，其中 13%到 35%为机器人手术。荷兰的微创远端胰腺切除术和机器人手术使用率均最高。接受微创远端胰腺切除术的患者年龄更轻（德国和瑞典）、女性（北美、德国）、体重指数更高（北美、荷兰、德国）、合并症分类较低（北美、德国、瑞典）、身体状态较好（德国），且胰腺腺癌比例较低（均为 P<0.001）。微创远端胰腺切除术组血管切除术较少（均为 P<0.001），严重并发症和死亡率较低（北美、德国）。多变量回归分析显示，国家与严重并发症相关，但与 30 天死亡率无关。与开放远端胰腺切除术相比，微创远端胰腺切除术与 30 天死亡率较低相关（比值比 1.633，95%可信区间 1.159-2.300，P=0.005）。
在四个跨大西洋胰腺手术登记处中，微创远端胰腺切除术的使用情况存在显著差异。总体而言，与开放远端胰腺切除术相比，微创远端胰腺切除术与死亡率降低相关。各国之间的患者选择差异可能意味着各国处于学习曲线的不同阶段。
