• Bas A Uijterwijk, Alma Moekotte, Ugo Boggi, Michele Mazzola, KoerkampBas GrootBGDepartment of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands., ValleRaffaele DallaRDUniversity Hospital of Parma, Department of Surgery, Parma, Italy., Alessandro Mazzotta, Misha Luyer, Geert Kazemier, Benedetto Ielpo, Miguel Angel Suarez Muñoz, Louisa Bolm, Bergthor Björnsson, Patrick Pessaux, Jorg Kleeff, Giuseppe Kito Fusai, Ernesto Sparrelid, Alessandro Zerbi, Daniël H Lemmers, Adnan Alseidi, Miljana Vladimirov, Keith J Roberts, Roberto Salvia, Zahir Soonawalla, Dimitris Korkolis, Mario Serradilla-Martín, Vasileios K Mavroeidis, BouwenseStefan A WSAWDepartment of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands., Marc G Besselink, Mohammed Abu Hilal, and International Study Group on non-pancreatic periampullary Cancer (ISGACA).
• Department of Surgery, Fondazione Poliambulanza, Brescia, Italy.
• Ann. Surg. 2024 Sep 2.

ObjectiveTo compare minimally invasive and open pancreatoduodenectomy in different subtypes of ampullary adenocarcinoma.Summary Background DataAmpullary adenocarcinoma (AAC) is widely seen as the best indication for minimally invasive pancreatoduodenectomy (MIPD) due to the lack of vascular involvement and dilated bile and pancreatic duct. However, it is unknown whether outcomes of MIPD for AAC differ between the pancreatobiliary (AAC-PB) and intestinal (AAC-IT) subtypes as large studies are lacking.MethodsThis is an international cohort study, encompassing 27 centers from 12 countries. Outcome of MIPD and open pancreatoduodenectomy (OPD) were compared in patients with AAC-IT and AAC-PB. Primary end points were R1 rate, lymph node yield, and 5-year overall survival (5yOS).ResultsOverall, 1187 patients after MIPD for AAC were included, of whom 572 with AAC-IT (62 MIPD, 510 OPD) and 615 with AAC-PB (41 MIPD and 574 OPD). The rate of R1 resection was not significantly different between MIPD and OPD for both AAC-IT (3.4% vs 6.9%, P=0,425) and AAC-PB (9.8% vs 14.9%, P=0,625). AAC-IT, more lymph nodes were resected with MIPD group (19 vs 16, P=0.007), compared to OPD. The 5y-OS did not differ after MIPD and OPD for both AAC-IT (56.8% vs 59.5%, P=0.827 and AAC-PB (52.5% vs 44.4%, P=0.357). The rates of surgical complication between MIPD and OPD did not differ between AmpIT and AmpPB.DiscussionThis international multicenter study found no differences in outcomes between MIPD and OPD for AAC-IT and AAC-PB. MIPD and OPD demonstrated comparable outcomes in oncological resection, survival and surgical outcomes for both subtypes of AAC.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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