Outcome of Minimally Invasive and Open Pancreatoduodenectomy in Patients With Intestinal and Pancreatobiliary Subtype Ampullary Cancer: An International Multicenter Cohort Study

Objective:To compare minimally invasive (MIPD) and open (OPD) pancreatoduodenectomy in different subtypes of ampullary adenocarcinoma (AAC).Background:AAC is widely seen as the best indication for 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. Outcomes of MIPD and OPD were compared in patients with AAC-IT and AAC-PB. Primary endpoints were R1 rate, lymph node yield, and 5-year overall survival.Results:Overall, 1187 patients after MIPD for AAC were included, of whom 572 with AAC-IT (62 MIPD and 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 the MIPD group (19 vs 16, P = 0.007), compared with OPD. The 5-year overall survival 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 complications between MIPD and OPD did not differ between AAC-IT and AAC-PB.Conclusions: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.