Laparoscopic versus open extended radical left pancreatectomy for pancreatic ductal adenocarcinoma: an international propensity-score matched study

Balduzzi A, van Hilst J, Korrel M, Lof S, Al-Sarireh B, Alseidi A, Berrevoet F, Björnsson B, van den Boezem P, Boggi U, Busch OR, Butturini G, Casadei R, van Dam R, Dokmak S, Edwin B, Sahakyan MA, Ercolani G, Fabre JM, Falconi M, Forgione A, Gayet B, Gomez D, Koerkamp BG, Hackert T, Keck T, Khatkov I, Krautz C, Marudanayagam R, Menon K, Pietrabissa A, Poves I, Cunha AS, Salvia R, Sánchez-Cabús S, Soonawalla Z, Hilal MA, Besselink MG (2021)

Publication Type: Journal article

Publication year: 2021

Journal

DOI: 10.1007/s00464-020-08206-y

Abstract

Background: A radical left pancreatectomy in patients with pancreatic ductal adenocarcinoma (PDAC) may require extended, multivisceral resections. The role of a laparoscopic approach in extended radical left pancreatectomy (ERLP) is unclear since comparative studies are lacking. The aim of this study was to compare outcomes after laparoscopic vs open ERLP in patients with PDAC. Methods: An international multicenter propensity-score matched study including patients who underwent either laparoscopic or open ERLP (L-ERLP; O-ERLP) for PDAC was performed (2007–2015). The ISGPS definition for extended resection was used. Primary outcomes were overall survival, margin negative rate (R0), and lymph node retrieval. Results: Between 2007 and 2015, 320 patients underwent ERLP in 34 centers from 12 countries (65 L-ERLP vs. 255 O-ERLP). After propensity-score matching, 44 L-ERLP could be matched to 44 O-ERLP. In the matched cohort, the conversion rate in L-ERLP group was 35%. The L-ERLP R0 resection rate (matched cohort) was comparable to O-ERLP (67% vs 48%; P = 0.063) but the lymph node yield was lower for L-ERLP than O-ERLP (median 11 vs 19, P = 0.023). L-ERLP was associated with less delayed gastric emptying (0% vs 16%, P = 0.006) and shorter hospital stay (median 9 vs 13 days, P = 0.005), as compared to O-ERLP. Outcomes were comparable for additional organ resections, vascular resections (besides splenic vessels), Clavien–Dindo grade ≥ III complications, or 90-day mortality (2% vs 2%, P = 0.973). The median overall survival was comparable between both groups (19 vs 20 months, P = 0.571). Conversion did not worsen outcomes in L-ERLP. Conclusion: The laparoscopic approach may be used safely in selected patients requiring ERLP for PDAC, since morbidity, mortality, and overall survival seem comparable, as compared to O-ERLP. L-ERLP is associated with a high conversion rate and reduced lymph node yield but also with less delayed gastric emptying and a shorter hospital stay, as compared to O-ERLP.

Authors with CRIS profile

Involved external institutions

University of Amsterdam Netherlands (NL) Morriston Hospital United Kingdom (GB) Virginia Mason Medical Center United States (USA) (US) University Hospital Ghent Belgium (BE) Linköpings universitet / Linköping University Sweden (SE) Radboud University Nijmegen Medical Centre / Radboudumc of voluit Radboud Universitair Medisch Centrum (UMC) Netherlands (NL) University of Pisa / Università di Pisa (UniPi) Italy (IT) Ospedale P. Pederzoli Italy (IT) Ospedale G.B. Morgagni - L.Pierantoni Italy (IT) Hôpital Saint Eloi France (FR) Università Vita-Salute San Raffaele (UniSR) Italy (IT) Ospedale Niguarda Ca' Granda / ASST Grande Ospedale Metropolitano Niguarda Italy (IT) Institute Mutualiste Montsouris (IMM) France (FR) Nottingham University Hospitals United Kingdom (GB) Erasmus University Medical Center (MC) Netherlands (NL) Universitätsklinikum Heidelberg Germany (DE) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) GBUZ Moscow Clinical Scientific Center Russian Federation (RU) University Hospitals Birmingham NHS Foundation Trust United Kingdom (GB) King's College Hospital (KCH) United Kingdom (GB) Università degli Studi di Pavia Italy (IT) Hospital del Mar Spain (ES) Hospital Clínic de Barcelona Spain (ES) Oxford University Hospitals NHS Foundation Trust United Kingdom (GB) University Hospital Southampton NHS United Kingdom (GB) University of Bologna / Università di Bologna Italy (IT) Maastricht University Netherlands (NL) Beaujon Hospital / Hôpital Beaujon France (FR) Oslo University Hospital / Oslo Universitetssykehus Rikshospitalet Norway (NO) Hôpital Paul-Brousse France (FR) University of Verona / Università degli Studi di Verona Italy (IT)

How to cite

APA:

Balduzzi, A., van Hilst, J., Korrel, M., Lof, S., Al-Sarireh, B., Alseidi, A.,... Besselink, M.G. (2021). Laparoscopic versus open extended radical left pancreatectomy for pancreatic ductal adenocarcinoma: an international propensity-score matched study. Surgical Endoscopy. https://doi.org/10.1007/s00464-020-08206-y

MLA:

Balduzzi, A., et al. "Laparoscopic versus open extended radical left pancreatectomy for pancreatic ductal adenocarcinoma: an international propensity-score matched study." Surgical Endoscopy (2021).

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