Uijterwijk Bas A, Moekotte Alma, Boggi Ugo, Mazzola Michele, Groot Koerkamp Bas, Dalle Valle Raffaele, Koek Sharnice, Bolm Louisa, Mazzotta Alessandro, Luyer Misha, Goh Brian K P, Suarez Muñoz Miguel A, Björnsson Bergthor, Kazemier Geert, Ielpo Benedetto, Pessaux Patrick, Kleeff Jorg, Ghorbani Poya, Mavroeidis Vasileios K, Fusai Giuseppe K, Salvia Roberto, Zerbi Alessandro, Roberts Keith J, Alseidi Adnan, Al-Sarireh Bilal, Serradilla-Martín Mario, Vladimirov Miljana, Korkolis Dimitris, Soonawalla Zahir, Gruppo Mario, Bouwense Stefan A W, Vollmer Charles M, Behrman Stephen W, Christein John D, Besselink Marc G, Abu Hilal Mohammed
Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands.
Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands.
HPB (Oxford). 2025 Mar;27(3):318-329. doi: 10.1016/j.hpb.2024.11.013. Epub 2024 Dec 11.
Ampullary adenocarcinoma (AAC) typically presents at an early stage due to biliary obstruction and therefore might be specifically suitable for minimally invasive pancreatoduodenectomy (MIPD). However, studies assessing MIPD specifically for AAC, including the robotic and laparoscopic approach, are limited. The aim of this study is to compare short- and long-term oncological resection and perioperative outcomes of robotic (RPD), laparoscopic (LPD) and open pancreatoduodenectomy (OPD) performed specifically for AAC.
In this multicenter international cohort study, encompassing 35 centers from 11 countries, MIPD versus OPD and subgroup analyses of LPD versus RPD were undertaken. The primary outcomes regarded the oncological resection (R1 resection rate, lymph node yield) and 5-years overall survival. Secondary outcomes were perioperative outcomes (including intra-operative variables, surgical complications and hospital stay).
In total, patients with AAC who underwent OPD (1721) or MIPD (141) were included. After propensity-score matching, 134 patients per cohort were included. The MIPD group consisted of 53 RPDs and 71 LPDs (50 per group after PSM). There was no difference in overall survival between MIPD and OPD (61.6 % vs 56.2 %, P = 0.215). In the MIPD group, operative time was longer (439 vs 360 min, P < 0.001). Between RPD and LPD, overall survival was not significantly different (75.8 % vs 47.4 %, P = 0.098) and lymph node yield was higher in RPD (21 vs 18, P = 0.014).
In conclusion, patients with AAC seem to have comparable oncological resection and perioperative outcomes from MIPD compared to the traditional OPD. Both RPD as LPD appear to be safe alternatives for patients with AAC, which warrants confirmation by future randomized studies.
壶腹腺癌（AAC）通常因胆道梗阻而在早期出现，因此可能特别适合微创胰十二指肠切除术（MIPD）。然而，专门评估针对AAC的MIPD（包括机器人手术和腹腔镜手术）的研究有限。本研究的目的是比较专门针对AAC进行的机器人胰十二指肠切除术（RPD）、腹腔镜胰十二指肠切除术（LPD）和开放胰十二指肠切除术（OPD）的短期和长期肿瘤切除及围手术期结果。
在这项多中心国际队列研究中，涵盖来自11个国家的35个中心，进行了MIPD与OPD的比较以及LPD与RPD的亚组分析。主要结局涉及肿瘤切除（R1切除率、淋巴结获取数量）和5年总生存率。次要结局为围手术期结果（包括术中变量、手术并发症和住院时间）。
总共纳入了接受OPD（1721例）或MIPD（141例）的AAC患者。经过倾向评分匹配后，每个队列纳入134例患者。MIPD组包括53例RPD和71例LPD（倾向评分匹配后每组50例）。MIPD和OPD的总生存率无差异（61.6%对56.2%，P = 0.215）。在MIPD组中，手术时间更长（分别为439分钟和360分钟，P < 0.001）。在RPD和LPD之间，总生存率无显著差异（75.8%对47.4%，P = 0.098），RPD的淋巴结获取数量更高（分别为21个和18个，P = 0.014）。
总之，与传统OPD相比，AAC患者接受MIPD的肿瘤切除及围手术期结果似乎相当。RPD和LPD对于AAC患者似乎都是安全的替代方案，这有待未来的随机研究证实。
