Objective: The aim of this study was to compare oncological outcomes after minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) in patients with pancreatic ductal adenocarcinoma (PDAC). Background: Cohort studies have suggested superior short-term outcomes of MIDP vs. ODP. Recent international surveys, however, revealed that surgeons have concerns about the oncological outcomes of MIDP for PDAC. Methods: This is a pan-European propensity score matched study including patients who underwent MIDP (laparoscopic or robot-assisted) or ODP for PDAC between January 1, 2007 and July 1, 2015. MIDP patients were matched to ODP patients in a 1:1 ratio. Main outcomes were radical (R0) resection, lymph node retrieval, and survival. Results: In total, 1212 patients were included from 34 centers in 11 countries. Of 356 (29%) MIDP patients, 340 could be matched. After matching, the MIDP conversion rate was 19% (n ¼ 62). Median blood loss [200 mL (60– 400) vs 300 mL (150–500), P ¼ 0.001] and hospital stay [8 (6–12) vs 9 (7– 14) days, P < 0.001] were lower after MIDP. Clavien-Dindo grade 3 complications (18% vs 21%, P ¼ 0.431) and 90-day mortality (2% vs 3%, P > 0.99) were comparable for MIDP and ODP, respectively. R0 resection rate was higher (67% vs 58%, P ¼ 0.019), whereas Gerota’s fascia resection (31% vs 60%, P < 0.001) and lymph node retrieval [14 (8–22) vs 22 (14–31), P < 0.001] were lower after MIDP. Median overall survival was 28 [95% confidence interval (CI), 22–34] versus 31 (95% CI, 26–36) months (P ¼ 0.929). Conclusions: Comparable survival was seen after MIDP and ODP for PDAC, but the opposing differences in R0 resection rate, resection of Gerota’s fascia, and lymph node retrieval strengthen the need for a randomized trial to confirm the oncological safety of MIDP

Additional Metadata
Keywords distal pancreatectomy, laparoscopic, left pancreatectomy, minimally invasive, robot-assisted
Persistent URL dx.doi.org/10.1097/sla.0000000000002561, hdl.handle.net/1765/116876
Journal Annals of Surgery
van Hilst, J., van Rooij, T, Klompmaker, S., Rawashdeh, M., Aleotti, F., & Al-Sarireh, B. (2019). Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA). Annals of Surgery, 269(1), 10–17. doi:10.1097/sla.0000000000002561