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Outcomes After Minimally Invasive Versus Open Total Pancreatectomy: A Pan-European Propensity Score Matched Study
Lianne Scholten1, Sjors Klompmaker1, Jony Van Hilst1
1Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Objective:
To assess postoperative 90-day outcomes after minimally invasive (laparoscopic/robot-assisted) total pancreatectomy (MITP) in selected patients versus open total pancreatectomy (OTP) among European centers.
Background:
Minimally invasive pancreatic surgery is becoming increasingly popular but data on MITP are scarce and multicenter studies comparing outcomes versus OTP are lacking. It therefore remains unclear if MITP is a valid alternative.
Methods:
Multicenter retrospective propensity-score matched study including consecutive adult patients undergoing MITP or OTP for all indications at 16 European centers in 7 countries (2008-2017). Patients after MITP were matched (1:1, caliper 0.02) to OTP controls. Missing data were imputed. The primary outcome was 90-day major morbidity (Clavien-Dindo ≥3a). Secondary outcomes included 90-day mortality, length of hospital stay, and survival.
Results:
Of 361 patients (99MITP/262 OTP), 70 MITP procedures (50 laparoscopic, 15 robotic, 5 hybrid) could be matched to 70 OTP controls. After matching, MITP was associated with a lower rate of major morbidity (17% MITP vs. 31% OTP, P = 0.022). The 90-day mortality (1.4% MITP vs. 7.1% OTP, P = 0.209) and median hospital stay (17 [IQR 11-24] MITP vs. 12 [10-23] days OTP, P = 0.876) did not differ significantly. Among 81 patients with PDAC, overall survival was 3.7 (IQR 1.7-N/A) versus 0.9 (IQR 0.5-N/ A) years, for MITP versus OTP, which was nonsignificant after stratification by T-stage.
Conclusion:
This international propensity score matched study showed that MITP may be a valuable alternative to OTP in selected patients, given the associated lower rate of major morbidity.
Insights
Minimally invasive total pancreatectomy (MITP) shows lower major morbidity compared to open total pancreatectomy (OTP). This study suggests MITP is a viable alternative for selected patients undergoing this complex pancreatic surgery.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Minimally invasive pancreatic surgery, including minimally invasive total pancreatectomy (MITP), is gaining traction.
- Limited multicenter data exists comparing MITP to open total pancreatectomy (OTP).
- The comparative efficacy and safety of MITP versus OTP remain unclear.
Purpose of the Study:
- To evaluate 90-day postoperative outcomes after MITP versus OTP in selected patients.
- To compare major morbidity, mortality, and hospital stay between MITP and OTP.
- To assess the potential of MITP as a valid alternative to OTP.
Main Methods:
- A multicenter, retrospective, propensity-score matched study was conducted across 16 European centers.
- Consecutive adult patients undergoing MITP or OTP for any indication between 2008 and 2017 were included.
- A 1:1 matching ratio (caliper 0.02) was used to compare 70 MITP patients with 70 OTP controls, with missing data imputed.
Main Results:
- Minimally invasive total pancreatectomy (MITP) was associated with significantly lower 90-day major morbidity (17% vs. 31%, P=0.022) compared to open total pancreatectomy (OTP).
- No significant differences were observed in 90-day mortality (1.4% vs. 7.1%, P=0.209) or median hospital stay (17 vs. 12 days, P=0.876).
- For patients with pancreatic ductal adenocarcinoma (PDAC), overall survival showed a trend favoring MITP but was not statistically significant after T-stage stratification.
Conclusions:
- Minimally invasive total pancreatectomy (MITP) demonstrates a lower rate of major morbidity compared to open total pancreatectomy (OTP).
- MITP represents a potentially valuable alternative to OTP for carefully selected patients.
- Further research may explore long-term survival benefits and optimal patient selection for MITP.
