Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA): a pan-European propensity score matched study

Abstract

Background: A recent survey revealed that many European surgeons have concerns about the oncological safety of minimally invasive distal pancreatectomy (MIDP) for pancreatic ductal adenocarcinoma (PDAC). Methods: A pan-European retrospective cohort study was performed on patients who underwent MIDP or open distal pancreatectomy (ODP) for PDAC (2007-2015). MIDP patients were matched to ODP patients (1:1) based on propensity scores obtained via multivariable logistic regression including only preoperatively variables: sex, age, BMI, ASA, prior abdominal surgery, surgery year, tumor location and size. Primary outcome was radical (R0) resection rate. Results: In total, 1336 patients were included from 33 centers in 11 countries. Mortality was 2% and median survival 29 months. Of 369(28%) MIDP patients, 239 could be matched to an ODP patient. Conversion rate was 21%(n=44). After matching, R0 resection rate was 66%(n=149) for MIDP vs 52%(n=119) for ODP (p=0.002), lymph node retrieval was 13(IQR=7-23) vs 19(IQR=12-26)(p<0.001), the use of adjuvant chemotherapy was 72% vs 67% (p=0.28) and median overall survival (31 vs 26 months (p=0.51). Major complication rate (Clavien-Dindo 3-4) was 16%(n=36) vs 24%(n=53)(p=0.06), 90-day mortality 1%(n=2) vs 2%(n=4)(P=0.44) and hospital stay 7(IQR=5-10) vs 9(IQR=7-14) days (p<0.001). Conclusion: This pan-European propensity score matched analysis suggests short term benefits for MIDP over ODP. A randomized controlled trial is, however, needed to confirm the oncologic safety of MIDP for PDAC.