Transatlantic Registries of Pancreatic Surgery in the USA, Germany, the Netherlands, and Sweden (GAPASURG): Comparing Variables, Patients, Treatment Strategies, and Outcomes

Abstract

Introduction: Pancreatic surgery registries facilitate both quality improvement and clinical research. We aimed to compare existing registries for variables collected, patient, tumor, and treatment characteristics, and outcomes. Methods: Fifty-one core parameters for pancreatoduodenectomies (2014-2017) in registries from the USA, Germany, the Netherlands, and Sweden were compared with relative and absolute largest differences (RLD; ALD) between extremes (smallest vs. largest). Results: Overall, 22983 pancreatoduodenectomies were included (15224, 3558, 2795, and 1406 in the USA, Germany, the Netherlands, and Sweden, respectively). Design of the registries varied as 18/51 (35.3%) core parameters were not available. Preoperative chemotherapy in patients with pancreatic ductal adenocarcinoma was administered most often in the USA (27.6%, 4.9%, 7.0%, and 3.4%, RLD 8.1, ALD 24.2%, p< 0.001). Minimally invasive procedures were performed most often in the Netherlands (7.8%, 4.5%, 13.5%, and unknown, RLD 3.0, ALD 9.0%, p< 0.001. Median length of stay was 8.0, 16.0, 12.0, and 11.0 days (RLD 2.0, ALD 8.0, p< 0.001). Reoperation was performed most frequently in Germany and Sweden (5.7%, 17.1%, 8.7%, and 11.2%, RLD 3.0, ALD 11.4%, p< 0.001). In-hospital mortality was 1.3%, 4.7%, 3.6%, and 2.7% (RLD 3.6, ALD 3.4%, p< 0.001). Conclusion: Considerable differences exist in design, patients, treatment strategies, and outcomes in registries of pancreatic surgery among four Western countries. The absolute largest nationwide differences of 24.3% for preoperative chemotherapy, 9.0% for minimally invasive surgery, 11.4% for reoperation rate, and 3.4% for in-hospital mortality require further study and improvement. This analysis provides core parameters for future registries on pancreatic surgery.