71342 - International differences in selection and outcome of minimally invasive and open distal pancreatectomy: a transatlantic analysis

Introduction The safety and efficacy of minimally invasive distal pancreatectomy (MIDP) has been confirmed within randomized trials. Information regarding differences in patient selection and outcomes of MIDP and open distal pancreatectomy (ODP) among countries is however lacking. This study compared MIDP and ODP in North America (NA), the Netherlands (NL), Germany (GER) and Sweden (SWE). Method Patients registered in the four pancreatic registries of the GAPASURG collaboration who underwent MIDP or ODP from 2014 to 2020 were included. Result Overall, 20 158 DPs were included; 7316 (36%) MIDP. Use of MIDP varied from 29% to 54% among registries, of which 13-35% were performed robotically (figure 1). Patients undergoing MIDP tended to be younger (GER and SWE), female (NA, GER), have higher body mass index (NA, NL, GER), lower comorbidity classification (NA, GER, SWE), lower performance status (GER), and lower rate of pancreatic ductal adenocarcinoma (all). Patients in the MIDP group had less vascular resections (all) and lower rates of severe complications and mortality (NA and GER). In the multivariable analysis, country was significantly associated with severe complications but not with 30-day mortality. Discussion Considerable disparities in the use and outcome of MIDP were shown among four transatlantic registries of pancreatic surgery. The differences in patient selection and outcomes imply that countries are in different stages of their learning curve.