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Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA)

(2019) ANNALS OF SURGERY. 269(1). p.10-17
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Abstract
Objective: The aim of this study was to compare oncological outcomes after minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) in patients with pancreatic ductal adenocarcinoma (PDAC). Background: Cohort studies have suggested superior short-term outcomes of MIDP vs. ODP. Recent international surveys, however, revealed that surgeons have concerns about the oncological outcomes of MIDP for PDAC. Methods: This is a pan-European propensity score matched study including patients who underwent MIDP (laparoscopic or robot-assisted) or ODP for PDAC between January 1, 2007 and July 1, 2015. MIDP patients were matched to ODP patients in a 1:1 ratio. Main outcomes were radical (R0) resection, lymph node retrieval, and survival. Results: In total, 1212 patients were included from 34 centers in 11 countries. Of 356 (29%) MIDP patients, 340 could be matched. After matching, the MIDP conversion rate was 19% (n = 62). Median blood loss [200 mL (60-400) vs 300 mL (150-500), P = 0.001] and hospital stay [8 (6-12) vs 9 (7-14) days, P < 0.001] were lower after MIDP. Clavien-Dindo grade >= 3 complications (18% vs 21%, P = 0.431) and 90-day mortality (2% vs 3%, P > 0.99) were comparable for MIDP and ODP, respectively. R0 resection rate was higher (67% vs 58%, P = 0.019), whereas Gerota's fascia resection (31% vs 60%, P < 0.001) and lymph node retrieval [14 (8-22) vs 22 (14-31), P < 0.001] were lower after MIDP. Median overall survival was 28 [95% confidence interval (CI), 22-34] versus 31 (95% CI, 26-36) months (P = 0.929). Conclusions: Comparable survival was seen after MIDP and ODP for PDAC, but the opposing differences in R0 resection rate, resection of Gerota's fascia, and lymph node retrieval strengthen the need for a randomized trial to confirm the oncological safety of MIDP.
Keywords
INTERNATIONAL STUDY-GROUP, METAANALYSIS, SURGERY, PANCREAS, SURVIVAL, TIME, PANCREATOSPLENECTOMY, DEFINITION, STATEMENT, RESECTION, distal pancreatectomy, laparoscopic, left pancreatectomy, minimally, invasive, robot-assisted

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MLA
van Hilst, Jony, et al. “Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA).” ANNALS OF SURGERY, vol. 269, no. 1, 2019, pp. 10–17.
APA
van Hilst, J., de Rooij, T., Klompmaker, S., Rawashdeh, M., Aleotti, F., Al-Sarireh, B., … Abu Hilal, M. (2019). Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA). ANNALS OF SURGERY, 269(1), 10–17.
Chicago author-date
Hilst, Jony van, Thijs de Rooij, Sjors Klompmaker, Majd Rawashdeh, Francesca Aleotti, Bilal Al-Sarireh, Adnan Alseidi, et al. 2019. “Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA).” ANNALS OF SURGERY 269 (1): 10–17.
Chicago author-date (all authors)
van Hilst, Jony, Thijs de Rooij, Sjors Klompmaker, Majd Rawashdeh, Francesca Aleotti, Bilal Al-Sarireh, Adnan Alseidi, Zeeshan Ateeb, Gianpaolo Balzano, Frederik Berrevoet, Bergthor Bjornsson, Ugo Boggi, Olivier R Busch, Giovanni Butturini, Riccardo Casadei, Marco Del Chiaro, Sophia Chikhladze, Federica Cipriani, Ronald van Dam, Isacco Damoli, Susan van Dieren, Safi Dokmak, Bjorn Edwin, Casper van Eijck, Jean-Marie Fabre, Massimo Falconi, Olivier Farges, Laureano Fernandez-Cruz, Antonello Forgione, Isabella Frigerio, David Fuks, Francesca Gavazzi, Brice Gayet, Alessandro Giardino, Bas Groot Koerkamp, Thilo Hackert, Matthias Hassenpflug, Irfan Kabir, Tobias Keck, Igor Khatkov, Masa Kusar, Carlo Lombardo, Giovanni Marchegiani, Ryne Marshall, Krish V Menon, Marco Montorsi, Marion Orville, Matteo de Pastena, Andrea Pietrabissa, Ignaci Poves, John Primrose, Raffaele Pugliese, Claudio Ricci, Keith Roberts, Bard Rosok, Mushegh A Sahakyan, Santiago Sanchez-Cabus, Per Sandstrom, Lauren Scovel, Leonardo Solaini, Zahir Soonawalla, F Regis Souche, Robert P Sutcliffe, Guido A Tiberio, Ales Tomazic, Roberto Troisi, Ulrich Wellner, Steven White, Uwe A Wittel, Alessandro Zerbi, Claudio Bassi, Marc G Besselink, and Mohammed Abu Hilal. 2019. “Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA).” ANNALS OF SURGERY 269 (1): 10–17.
Vancouver
1.
van Hilst J, de Rooij T, Klompmaker S, Rawashdeh M, Aleotti F, Al-Sarireh B, et al. Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA). ANNALS OF SURGERY. 2019;269(1):10–7.
IEEE
[1]
J. van Hilst et al., “Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA),” ANNALS OF SURGERY, vol. 269, no. 1, pp. 10–17, 2019.
@article{8650197,
  abstract     = {{Objective: The aim of this study was to compare oncological outcomes after minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) in patients with pancreatic ductal adenocarcinoma (PDAC). 
Background: Cohort studies have suggested superior short-term outcomes of MIDP vs. ODP. Recent international surveys, however, revealed that surgeons have concerns about the oncological outcomes of MIDP for PDAC. 
Methods: This is a pan-European propensity score matched study including patients who underwent MIDP (laparoscopic or robot-assisted) or ODP for PDAC between January 1, 2007 and July 1, 2015. MIDP patients were matched to ODP patients in a 1:1 ratio. Main outcomes were radical (R0) resection, lymph node retrieval, and survival. 
Results: In total, 1212 patients were included from 34 centers in 11 countries. Of 356 (29%) MIDP patients, 340 could be matched. After matching, the MIDP conversion rate was 19% (n = 62). Median blood loss [200 mL (60-400) vs 300 mL (150-500), P = 0.001] and hospital stay [8 (6-12) vs 9 (7-14) days, P < 0.001] were lower after MIDP. Clavien-Dindo grade >= 3 complications (18% vs 21%, P = 0.431) and 90-day mortality (2% vs 3%, P > 0.99) were comparable for MIDP and ODP, respectively. R0 resection rate was higher (67% vs 58%, P = 0.019), whereas Gerota's fascia resection (31% vs 60%, P < 0.001) and lymph node retrieval [14 (8-22) vs 22 (14-31), P < 0.001] were lower after MIDP. Median overall survival was 28 [95% confidence interval (CI), 22-34] versus 31 (95% CI, 26-36) months (P = 0.929). 
Conclusions: Comparable survival was seen after MIDP and ODP for PDAC, but the opposing differences in R0 resection rate, resection of Gerota's fascia, and lymph node retrieval strengthen the need for a randomized trial to confirm the oncological safety of MIDP.}},
  author       = {{van Hilst, Jony and de Rooij, Thijs and Klompmaker, Sjors and Rawashdeh, Majd and Aleotti, Francesca and Al-Sarireh, Bilal and Alseidi, Adnan and Ateeb, Zeeshan and Balzano, Gianpaolo and Berrevoet, Frederik and Bjornsson, Bergthor and Boggi, Ugo and Busch, Olivier R and Butturini, Giovanni and Casadei, Riccardo and Del Chiaro, Marco and Chikhladze, Sophia and Cipriani, Federica and van Dam, Ronald and Damoli, Isacco and van Dieren, Susan and Dokmak, Safi and Edwin, Bjorn and van Eijck, Casper and Fabre, Jean-Marie and Falconi, Massimo and Farges, Olivier and Fernandez-Cruz, Laureano and Forgione, Antonello and Frigerio, Isabella and Fuks, David and Gavazzi, Francesca and Gayet, Brice and Giardino, Alessandro and Koerkamp, Bas Groot and Hackert, Thilo and Hassenpflug, Matthias and Kabir, Irfan and Keck, Tobias and Khatkov, Igor and Kusar, Masa and Lombardo, Carlo and Marchegiani, Giovanni and Marshall, Ryne and Menon, Krish V and Montorsi, Marco and Orville, Marion and de Pastena, Matteo and Pietrabissa, Andrea and Poves, Ignaci and Primrose, John and Pugliese, Raffaele and Ricci, Claudio and Roberts, Keith and Rosok, Bard and Sahakyan, Mushegh A and Sanchez-Cabus, Santiago and Sandstrom, Per and Scovel, Lauren and Solaini, Leonardo and Soonawalla, Zahir and Souche, F Regis and Sutcliffe, Robert P and Tiberio, Guido A and Tomazic, Ales and Troisi, Roberto and Wellner, Ulrich and White, Steven and Wittel, Uwe A and Zerbi, Alessandro and Bassi, Claudio and Besselink, Marc G and Abu Hilal, Mohammed}},
  issn         = {{0003-4932}},
  journal      = {{ANNALS OF SURGERY}},
  keywords     = {{INTERNATIONAL STUDY-GROUP,METAANALYSIS,SURGERY,PANCREAS,SURVIVAL,TIME,PANCREATOSPLENECTOMY,DEFINITION,STATEMENT,RESECTION,distal pancreatectomy,laparoscopic,left pancreatectomy,minimally,invasive,robot-assisted}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{10--17}},
  title        = {{Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA)}},
  url          = {{http://dx.doi.org/10.1097/SLA.0000000000002561}},
  volume       = {{269}},
  year         = {{2019}},
}

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