TY - JOUR
T1 - International Validation of Reduced Major Morbidity After Minimally Invasive Distal Pancreatectomy Compared With Open Pancreatectomy
AU - Klompmaker, Sjors
AU - de Rooij, Thijs
AU - Koerkamp, Bas Groot
AU - Shankar, Anuraj H.
AU - Dutch Pancreatic Cancer Group
AU - Siebert, Uwe
AU - Besselink, Marc G.
AU - Moser, A. James
N1 - Funding Information:
Funding: This project was funded by non-profit partners: The Netherland-America-Foundation Fulbright Scholarship Program, the Alliance of Families Fighting Pancreatic Cancer, the Greg & Cathy Griffith Family Foundation, the John F. Fortney Foundation.
Funding Information:
We acknowledge the important contributions from Mary Beth Cotter and Mary Ward at Beth Israel Deaconess Medical Center and the principal investigators of the Dutch Pancreatic Cancer Group (DPCG). We are grateful for generous donations from nonprofit partners: the Netherland-America Foundation Fulbright Scholarship Program, the Alliance of Families Fighting Pancreatic Cancer, the Griffith Family Foundation, and the John F. Fortney Charitable Pancreatic Cancer Research Group. This paper reports the results of a study that was preregistered and approved by the Dutch Pancreatic Cancer Group Scientific Committee, accessible upon request via www.dpcg.nl .
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Objective:To quantify the nationwide impact of minimally invasive distal pancreatectomy (MIDP) on major morbidity as compared with open distal pancreatectomy (ODP).Background:A recent randomized controlled trial (RCT) demonstrated significant reduction in time to functional recovery after MIDP compared with ODP, but was not powered to assess potential risk reductions in major morbidity.Methods:International cohort study using the American College of Surgeons' National Quality Improvement Program (ACS-NSQIP) (88 centers; 2014-2016) to evaluate the association between surgical approach (MIDP vs ODP) and 30-day composite major morbidity (CMM; death or severe complications) with external model validation using Dutch Pancreatic Cancer Group data (17 centers; 2005-2016). Multivariable logistic regression assessed the impact of nationwide MIDP rates between 0% and 100% on postoperative CMM at conversion rates between 0% and 25%, using estimated marginal effects. A sensitivity analysis tested the impact at various scenarios and patient populations.Results:Of 2921 ACS-NSQIP patients, 1562 (53%) underwent MIDP with 18% conversion, and 1359 (47%) underwent ODP. MIDP was independently associated with reduced CMM [odds ratio (OR) 0.50, 95% confidence interval (CI) 0.42-0.60, P < 0.001], confirmed by external model validation (n = 637, P < 0.003). The association between rising MIDP implementation rates and falling postoperative morbidity was linear between 0% (all ODP) and 100% (all MIDP). The absolute risk reduction for CMM was 11% (95% CI 7.3%-15%) at observed conversion rates and improved to 14% (95% CI 11%-18%) as conversion approached 0%. Similar effects were seen across subgroups.Conclusion:This international study predicted a nationwide 11% risk reduction for CMM after MIDP versus ODP, which is likely to improve as conversion rates decrease. These findings confirm secondary outcomes of the recent LEOPARD RCT.
AB - Objective:To quantify the nationwide impact of minimally invasive distal pancreatectomy (MIDP) on major morbidity as compared with open distal pancreatectomy (ODP).Background:A recent randomized controlled trial (RCT) demonstrated significant reduction in time to functional recovery after MIDP compared with ODP, but was not powered to assess potential risk reductions in major morbidity.Methods:International cohort study using the American College of Surgeons' National Quality Improvement Program (ACS-NSQIP) (88 centers; 2014-2016) to evaluate the association between surgical approach (MIDP vs ODP) and 30-day composite major morbidity (CMM; death or severe complications) with external model validation using Dutch Pancreatic Cancer Group data (17 centers; 2005-2016). Multivariable logistic regression assessed the impact of nationwide MIDP rates between 0% and 100% on postoperative CMM at conversion rates between 0% and 25%, using estimated marginal effects. A sensitivity analysis tested the impact at various scenarios and patient populations.Results:Of 2921 ACS-NSQIP patients, 1562 (53%) underwent MIDP with 18% conversion, and 1359 (47%) underwent ODP. MIDP was independently associated with reduced CMM [odds ratio (OR) 0.50, 95% confidence interval (CI) 0.42-0.60, P < 0.001], confirmed by external model validation (n = 637, P < 0.003). The association between rising MIDP implementation rates and falling postoperative morbidity was linear between 0% (all ODP) and 100% (all MIDP). The absolute risk reduction for CMM was 11% (95% CI 7.3%-15%) at observed conversion rates and improved to 14% (95% CI 11%-18%) as conversion approached 0%. Similar effects were seen across subgroups.Conclusion:This international study predicted a nationwide 11% risk reduction for CMM after MIDP versus ODP, which is likely to improve as conversion rates decrease. These findings confirm secondary outcomes of the recent LEOPARD RCT.
KW - comparative effectiveness research
KW - decision support techniques
KW - elective surgical procedures/utilization
KW - minimally invasive surgical procedures
KW - pancreas/surgery
KW - pancreatic neoplasms
UR - https://www.scopus.com/pages/publications/85121968394
U2 - 10.1097/SLA.0000000000003659
DO - 10.1097/SLA.0000000000003659
M3 - Article
C2 - 31756173
SN - 0003-4932
VL - 274
SP - e966-e973
JO - Annals of Surgery
JF - Annals of Surgery
IS - 6
ER -
SDG 3 Good Health and Well-being