Oncological resection and perioperative outcomes of robotic, laparoscopic and open pancreatoduodenectomy for ampullary adenocarcinoma: a propensity score matched international multicenter cohort study

Bas A Uijterwijk; Alma Moekotte; Ugo Boggi; Michele Mazzola; Bas Groot Koerkamp; Raffaele Dalle Valle; Sharnice Koek; Louisa Bolm; Alessandro Mazzotta; Misha Luyer; Brian K P Goh; Miguel A Suarez Muñoz; Bergthor Björnsson; Geert Kazemier; Benedetto Ielpo; Patrick Pessaux; Jorg Kleeff; Poya Ghorbani; Vasileios K Mavroeidis; Giuseppe K Fusai; Roberto Salvia; Alessandro Zerbi; Keith J Roberts; Adnan Alseidi; Bilal Al-Sarireh; Mario Serradilla-Martín; Miljana Vladimirov; Dimitris Korkolis; Zahir Soonawalla; Mario Gruppo; Stefan A W Bouwense; Charles M Vollmer; Stephen W Behrman; John D Christein; Marc G Besselink; Mohammed Abu Hilal; International Study Group on non-pancreatic periampullary Cancer (ISGACA)

doi:10.1016/j.hpb.2024.11.013

Oncological resection and perioperative outcomes of robotic, laparoscopic and open pancreatoduodenectomy for ampullary adenocarcinoma: a propensity score matched international multicenter cohort study

HPB (Oxford). 2024 Dec 11:S1365-182X(24)02428-6. doi: 10.1016/j.hpb.2024.11.013. Online ahead of print.

Authors

Bas A Uijterwijk¹, Alma Moekotte², Ugo Boggi³, Michele Mazzola⁴, Bas Groot Koerkamp⁵, Raffaele Dalle Valle⁶, Sharnice Koek⁷, Louisa Bolm⁸, Alessandro Mazzotta⁹, Misha Luyer¹⁰, Brian K P Goh¹¹, Miguel A Suarez Muñoz¹², Bergthor Björnsson¹³, Geert Kazemier¹⁴, Benedetto Ielpo¹⁵, Patrick Pessaux¹⁶, Jorg Kleeff¹⁷, Poya Ghorbani¹⁸, Vasileios K Mavroeidis¹⁹, Giuseppe K Fusai²⁰, Roberto Salvia²¹, Alessandro Zerbi²², Keith J Roberts²³, Adnan Alseidi²⁴, Bilal Al-Sarireh²⁵, Mario Serradilla-Martín²⁶, Miljana Vladimirov²⁷, Dimitris Korkolis²⁸, Zahir Soonawalla²⁹, Mario Gruppo³⁰, Stefan A W Bouwense³¹, Charles M Vollmer³², Stephen W Behrman³³, John D Christein³⁴, Marc G Besselink², Mohammed Abu Hilal³⁵; International Study Group on non-pancreatic periampullary Cancer (ISGACA)

Collaborators

International Study Group on non-pancreatic periampullary Cancer (ISGACA):
Laurence Webber, Ulrich Wellner, Mark Ramaekers, Ernesto Sparrelid, Giuseppe Malleo, Alejandro Ramirez-Del Val, Francesco Lancelotti, Gennaro Nappo, James Halle-Smith, Tara S Kent, Judith de Vos-Geelen, Anouk de Wilde, Daniël H Lemmers, Ricky Bhogal, Karin Johansen, Alessandro Giani, Fabio Giannone, Brett Ecker

Affiliations

¹ Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands. Electronic address: basuijterwijk@live.nl.
² Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands.
³ Department of Surgery, Pisa University Hospital, Pisa, Italy.
⁴ Division of Oncologic and Mini-invasive General Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
⁵ Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
⁶ University Hospital of Parma, Department of Surgery, Parma, Italy.
⁷ Fiona Stanley Hospital, Department of Surgery, Perth, Australia.
⁸ Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany.
⁹ Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France.
¹⁰ Catharina Hospital Eindhoven, Department of Surgery, the Netherlands.
¹¹ Singapore General Hospital, Department of Hepatopancreatobiliary and Transplant Surgery, Duke-National University of Singapore, Singapore.
¹² Department of Surgery, University Hospital Virgen de La Victoria, Malaga, Spain.
¹³ Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
¹⁴ Department of Surgery, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands.
¹⁵ Department of Surgery, Hospital del Mar, Barcelona, Spain.
¹⁶ Hepatobiliary and Pancreatic Surgical Unit, Nouvel Hôpital Civil (NHC), Strasbourg, France.
¹⁷ Department of Surgery, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany.
¹⁸ Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
¹⁹ Department of Academic Surgery, The Royal Marsden Hospital, London, UK; Department of Hepatobiliary and Pancreatic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
²⁰ Department of Surgery, Royal Free London NHS Foundation Trust, London, UK.
²¹ Department of General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
²² Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Pancreatic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Italy.
²³ Faculty of Medicine, University of Birmingham, Birmingham, UK.
²⁴ Department of Surgery, Virginia Mason, Seattle, USA.
²⁵ Department of Surgery, Morriston Hospital, Swansea, UK.
²⁶ Instituto de Investigación Sanitaria Aragón, Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain.
²⁷ Department of General Surgery, Paracelsus Medical University Nürnberg, 90419, Nürnberg, Germany; Department of Abdominal Surgery, University Hospital Lippe, University Bielefeld, Campus Detmold, Germany.
²⁸ Department of Surgery, Hellenic Anticancer Hospital 'Saint Savvas', Athens, Greece.
²⁹ Department of Hepatobiliary and Pancreatic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
³⁰ Veneto Institute of Oncology IOV - IRCCS, Unit of Surgical Oncology of the Digestive Tract, Italy.
³¹ Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands.
³² Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
³³ Department of Surgery, University of Tennessee Health Science Center, Memphis, USA.
³⁴ Department of Surgery, University of Alabama School of Medicine, Birmingham, USA.
³⁵ Department of Surgery, Fondazione Poliambulanza, Brescia, Italy. Electronic address: abuhilal9@gmail.com.

PMID: 39765373
DOI: 10.1016/j.hpb.2024.11.013

Abstract

Background: 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.

Methods: 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).

Results: 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).

Conclusion: 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.