• Bas A Uijterwijk, Daniël H L Lemmers, Louisa Bolm, Misha Luyer, Ye Xin Koh, Michele Mazzola, Laurence Webber, Geert Kazemier, Elisa Bannone, Mark Ramaekers, Benedetto Ielpo, Ulrich Wellner, Sharnice Koek, Alessandro Giani, Marc G Besselink, Mohammed Abu Hilal, and ISGACA consortium, the International study group on non-pancreatic periampullary cancer.
• Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
• Ann. Surg. 2023 Sep 1; 278 (3): e570e579e570-e579.

ObjectiveThis study aimed to compare surgical and oncological outcomes after minimally invasive pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) for distal cholangiocarcinoma (dCCA).BackgroundA dCCA might be a good indication for MIPD, as it is often diagnosed as primary resectable disease. However, multicenter series on MIPD for dCCA are lacking.MethodsThis is an international multicenter propensity score-matched cohort study including patients after MIPD or OPD for dCCA in 8 centers from 5 countries (2010-2021). Primary outcomes included overall survival (OS) and disease-free interval (DFI). Secondary outcomes included perioperative and postoperative complications and predictors for OS or DFI. Subgroup analyses included robotic pancreatoduodenectomy (RPD) and laparoscopic pancreatoduodenectomy (LPD).ResultsOverall, 478 patients after pancreatoduodenectomy for dCCA were included of which 97 after MIPD (37 RPD, 60 LPD) and 381 after OPD. MIPD was associated with less blood loss (300 vs 420 mL, P =0.025), longer operation time (453 vs 340 min; P <0.001), and less surgical site infections (7.8% vs 19.3%; P =0.042) compared with OPD. The median OS (30 vs 25 mo) and DFI (29 vs 18) for MIPD did not differ significantly between MIPD and OPD. Tumor stage (Hazard ratio: 2.939, P <0.001) and administration of adjuvant chemotherapy (Hazard ratio: 0.640, P =0.033) were individual predictors for OS. RPD was associated with a higher lymph node yield (18.0 vs 13.5; P =0.008) and less major morbidity (Clavien-Dindo 3b-5; 8.1% vs 32.1%; P =0.005) compared with LPD.DiscussionBoth surgical and oncological outcomes of MIPD for dCCA are acceptable as compared with OPD. Surgical outcomes seem to favor RPD as compared with LPD but more data are needed. Randomized controlled trials should be performed to confirm these findings.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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