• Sjors Klompmaker, Jony van Hilst, Ulrich F Wellner, Olivier R Busch, Andrea Coratti, Mathieu D'Hondt, Safi Dokmak, Sebastiaan Festen, Mustafa Kerem, Igor Khatkov, Daan J Lips, Carlo Lombardo, Misha Luyer, Alberto Manzoni, Izaäk Q Molenaar, Edoardo Rosso, Olivier Saint-Marc, Franky Vansteenkiste, Uwe A Wittel, Bert Bonsing, Bas Groot Koerkamp, Mohammed Abu Hilal, David Fuks, Ignasi Poves, Tobias Keck, Ugo Boggi, Marc G Besselink, and European consortium on Minimally Invasive Pancreatic Surgery (E-MIPS).
• Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, University of Amsterdam, the Netherlands.
• Ann. Surg. 2020 Feb 1; 271 (2): 356-363.

ObjectiveTo assess short-term outcomes after minimally invasive (laparoscopic, robot-assisted, and hybrid) pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) among European centers.BackgroundCurrent evidence on MIPD is based on national registries or single expert centers. International, matched studies comparing outcomes for MIPD and OPD are lacking.MethodsRetrospective propensity score matched study comparing MIPD in 14 centers (7 countries) performing ≥10 MIPDs annually (2012-2017) versus OPD in 53 German/Dutch surgical registry centers performing ≥10 OPDs annually (2014-2017). Primary outcome was 30-day major morbidity (Clavien-Dindo ≥3).ResultsOf 4220 patients, 729/730 MIPDs (412 laparoscopic, 184 robot-assisted, and 130 hybrid) were matched to 729 OPDs. Median annual case-volume was 19 MIPDs (interquartile range, IQR 13-22), including the first MIPDs performed in 10/14 centers, and 31 OPDs (IQR 21-38). Major morbidity (28% vs 30%, P = 0.526), mortality (4.0% vs 3.3%, P = 0.576), percutaneous drainage (12% vs 12%, P = 0.809), reoperation (11% vs 13%, P = 0.329), and hospital stay (mean 17 vs 17 days, P > 0.99) were comparable between MIPD and OPD. Grade-B/C postoperative pancreatic fistula (POPF) (23% vs 13%, P < 0.001) occurred more frequently after MIPD. Single-row pancreatojejunostomy was associated with POPF in MIPD (odds ratio, OR 2.95, P < 0.001), but not in OPD. Laparoscopic, robot-assisted, and hybrid MIPD had comparable major morbidity (27% vs 27% vs 35%), POPF (24% vs 19% vs 25%), and mortality (2.9% vs 5.2% vs 5.4%), with a fewer conversions in robot-assisted- versus laparoscopic MIPD (5% vs 26%, P < 0.001).ConclusionsIn the early experience of 14 European centers performing ≥10 MIPDs annually, no differences were found in major morbidity, mortality, and hospital stay between MIPD and OPD. The high rates of POPF and conversion, and the lack of superior outcomes (ie, hospital stay, morbidity) could indicate that more experience and higher annual MIPD volumes are needed.

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