de Graaf Nine, Augustinus Simone, Wellner Ulrich F, Johansen Karin, Andersson Bodil, Beane Joal D, Björnsson Bergthor, Busch Olivier R, Davis Catherine H, Ghadimi Michael, Gleeson Elizabeth M, Groot Koerkamp Bas, Hogg Melissa E, van Santvoort Hjalmar C, Tingstedt Bobby, Uhl Waldemar, Werner Jens, Williamsson Caroline, Zeh Herbert J, Zureikat Amer H, Abu Hilal Mohammad, Pitt Henry A, Besselink Marc G, Keck Tobias
Cancer Center Amsterdam, Amsterdam, the Netherlands.
Fondazione Poliabulanza Istituto Ospedaliero, Brescia, Italy.
Surg Endosc. 2024 Dec;38(12):7099-7111. doi: 10.1007/s00464-024-11161-7. Epub 2024 Sep 28.
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.
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.
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.
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.
微创胰十二指肠切除术（MIPD）已成为开放性胰十二指肠切除术（OPD）的替代方案。然而，由于缺乏使用登记数据的国际研究，各国在MIPD相对于OPD的使用和结果方面的差异程度尚不清楚。本研究旨在调查四项跨大西洋胰腺手术审计中MIPD和OPD的使用情况、患者选择和结果。
进行一项事后比较分析，纳入来自北美、德国、荷兰和瑞典的四项全国性多中心胰腺手术审计中接受MIPD和OPD治疗的连续患者（2014 - 2020年）。使用多变量逻辑回归确定与MIPD相关的患者因素。结果分析排除了瑞典的审计，因为在研究期间进行的MIPD少于100例。
总体而言，纳入了44076例行胰十二指肠切除术的患者（北美29107例、德国7586例、荷兰4970例、瑞典2413例），其中包括3328例MIPD手术（8%）。各国MIPD的使用差异很大（绝对最大差异[ALD]为17%，p < 0.001）：北美为7%，德国为4%，荷兰为17%，瑞典为0.1%。随着时间的推移，北美和荷兰的MIPD使用量增加（p < 0.001），主要由机器人辅助MIPD推动，但德国没有增加（p = 0.297）。预测使用MIPD的患者因素包括国家、手术年份较晚、身体状况较好、高胰瘘风险评分、无血管切除和非恶性指征。腹腔镜MIPD的中转率较高（范围为28 - 45%），而机器人辅助MIPD的中转率较低（范围为9 - 37%）。北美、德国和荷兰的住院/30天死亡率存在差异；MIPD分别为2%、7%、4%（ALD为5%，p < 0.001），OPD分别为2%、5%、3%（ALD为3%，p < 0.001），主要并发症情况类似；MIPD分别为25%、42%、38%（ALD为17%，p < 0.001），OPD分别为25%、31%、30%（ALD为6%，p < 0.001）。
在四项跨大西洋胰腺手术审计中，MIPD和OPD在使用和结果（包括中转率和死亡率）方面存在显著差异。我们的研究结果强调了国际合作以优化治疗标准和患者预后的必要性。
