OBJECTIVE To compare minimally invasive and open pancreatoduodenectomy in different subtypes of ampullary adenocarcinoma. SUMMARY BACKGROUND DATA Ampullary adenocarcinoma (AAC) is widely seen as the best indication for minimally invasive pancreatoduodenectomy (MIPD) due to the lack of vascular involvement and dilated bile and pancreatic duct. However, it is unknown whether outcomes of MIPD for AAC differ between the pancreatobiliary (AAC-PB) and intestinal (AAC-IT) subtypes as large studies are lacking. METHODS This is an international cohort study, encompassing 27 centers from 12 countries. Outcome of MIPD and open pancreatoduodenectomy (OPD) were compared in patients with AAC-IT and AAC-PB. Primary end points were R1 rate, lymph node yield, and 5-year overall survival (5yOS). RESULTS Overall, 1187 patients after MIPD for AAC were included, of whom 572 with AAC-IT (62 MIPD, 510 OPD) and 615 with AAC-PB (41 MIPD and 574 OPD). The rate of R1 resection was not significantly different between MIPD and OPD for both AAC-IT (3.4% vs 6.9%, P=0,425) and AAC-PB (9.8% vs 14.9%, P=0,625). AAC-IT, more lymph nodes were resected with MIPD group (19 vs 16, P=0.007), compared to OPD. The 5y-OS did not differ after MIPD and OPD for both AAC-IT (56.8% vs 59.5%, P=0.827 and AAC-PB (52.5% vs 44.4%, P=0.357). The rates of surgical complication between MIPD and OPD did not differ between AmpIT and AmpPB. DISCUSSION This international multicenter study found no differences in outcomes between MIPD and OPD for AAC-IT and AAC-PB. MIPD and OPD demonstrated comparable outcomes in oncological resection, survival and surgical outcomes for both subtypes of AAC.

中文翻译：

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肠和胰胆亚型壶腹癌患者微创和开放性胰十二指肠切除术的结果：一项国际多中心队列研究。


目的 比较微创与开腹胰十二指肠切除术治疗不同亚型壶腹腺癌的效果。摘要背景数据壶腹腺癌（AAC）由于缺乏血管受累以及胆汁和胰管扩张，被广泛认为是微创胰十二指肠切除术（MIPD）的最佳适应症。然而，由于缺乏大型研究，尚不清楚胰胆亚型 (AAC-PB) 和肠亚型 (AAC-IT) 的 MIPD 治疗 AAC 的结果是否存在差异。方法 这是一项国际队列研究，涵盖来自 12 个国家的 27 个中心。比较 AAC-IT 和 AAC-PB 患者的 MIPD 和开放性胰十二指肠切除术 (OPD) 的结果。主要终点是 R1 率、淋巴结产量和 5 年总生存率 (5yOS)。结果 总体而言，纳入了 1187 名接受 MIPD 治疗 AAC 的患者，其中 572 名接受 AAC-IT（62 名 MIPD，510 名 OPD），615 名接受 AAC-PB（41 名 MIPD 和 574 名 OPD）。对于 AAC-IT（3.4% vs 6.9%，P=0,425）和 AAC-PB（9.8% vs 14.9%，P=0,625），MIPD 和 OPD 之间的 R1 切除率没有显着差异。 AAC-IT 组中，与 OPD 组相比，MIPD 组切除了更多淋巴结（19 vs 16，P=0.007）。 MIPD 和 OPD 后，AAC-IT（56.8% vs 59.5%，P=0.827）和 AAC-PB（52.5% vs 44.4%，P=0.357）的 5y-OS 没有差异。MIPD 和 OPD 之间的手术并发症发生率AmpIT 和 AmpPB 之间的 OPD 没有差异。这项国际多中心研究发现，AAC-IT 和 AAC-PB 的 MIPD 和 OPD 的结果没有差异，两种亚型的肿瘤切除、生存和手术结果具有可比性。 AA.