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

Bas A. Uijterwijk; Alma Moekotte; Ugo Boggi; Michele Mazzola; Bas Groot Koerkamp; Raffaele Dalla Valle; Alessandro Mazzotta; Misha Luyer; Geert Kazemier; Benedetto Ielpo; Miguel Angel Suarez Muñoz; Louisa Bolm; Bergthor Björnsson; Patrick Pessaux; Jorg Kleeff; Giuseppe Kito Fusai; Ernesto Sparrelid; Alessandro Zerbi; Daniël H. Lemmers; Adnan Alseidi; Miljana Vladimirov; Keith J. Roberts; Roberto Salvia; Zahir Soonawalla; Dimitris Korkolis; Mario Serradilla-Martín; Vasileios K. Mavroeidis; Stefan A.W. Bouwense; Marc G. Besselink; Mohammed Abu Hilal; Laurence Webber; Laurence Webber; Ulrich Wellner; Mark Ramaekers; Poya Ghorbani; Giuseppe Malleo; Gennaro Nappo; James Halle-Smith; Anouk de Wilde; Judith de Vos Geelen; Karin Johansen; Tara S. Kent; Alessandro Giani

doi:10.1097/SLA.0000000000006515

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

Bas A. Uijterwijk^*, Alma Moekotte, Ugo Boggi, Michele Mazzola, Bas Groot Koerkamp, Raffaele Dalla Valle, Alessandro Mazzotta, Misha Luyer, Geert Kazemier, Benedetto Ielpo, Miguel Angel Suarez Muñoz, Louisa Bolm, Bergthor Björnsson, Patrick Pessaux, Jorg Kleeff, Giuseppe Kito Fusai, Ernesto Sparrelid, Alessandro Zerbi, Daniël H. Lemmers, Adnan AlseidiMiljana Vladimirov, Keith J. Roberts, Roberto Salvia, Zahir Soonawalla, Dimitris Korkolis, Mario Serradilla-Martín, Vasileios K. Mavroeidis, Stefan A.W. Bouwense, Marc G. Besselink, Mohammed Abu Hilal^*, Laurence Webber, Laurence Webber, Ulrich Wellner, Mark Ramaekers, Poya Ghorbani, Giuseppe Malleo, Gennaro Nappo, James Halle-Smith, Anouk de Wilde, Judith de Vos Geelen, Karin Johansen, Tara S. Kent, Alessandro Giani

^*Corresponding author for this work

Department of Surgery

2 Citations (Scopus)

Abstract

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.

Original language	English
Journal	Annals of Surgery
Volume	283
Issue number	5
Pages (from-to)	848-854
Number of pages	7
ISSN	0003-4932
DOIs	https://doi.org/10.1097/SLA.0000000000006515
Publication status	Published - 05.2026

Funding

Conflicts of interests : Mario Serradilla-Martín received research funding from Baxter S.L.. Patrick Pessaux is co-founder of Virtualisurg; Geert Kazemier is Chairman of the Advisory Board of Renovaro Inc.; Marc G. Besselink has received grants from Intuitive for the LEARNBOT European robot Whipple training program, the DIPLOMA-2 trial, and the E-MIPS quality registry, from Medtronic for the investigator-initiated DIPLOMA trial and from Ethicon for the PANDORA trial and the E-MIPS quality registry; Mohammed Abu Hilal received funding from Associazione Italiana per la Ricerca sul Cancro (AIRC); All remaining authors claim no conflicts of interests and no disclosures.

Funders	Funder number
Medtronic
Associazione Italiana per la Ricerca sul Cancro

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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10.1097/SLA.0000000000006515

Cite this

Uijterwijk, B. A., Moekotte, A., Boggi, U., Mazzola, M., Groot Koerkamp, B., Valle, R. D., Mazzotta, A., Luyer, M., Kazemier, G., Ielpo, B., Suarez Muñoz, M. A., Bolm, L., Björnsson, B., Pessaux, P., Kleeff, J., Fusai, G. K., Sparrelid, E., Zerbi, A., Lemmers, D. H., ... Giani, A. (2026). Outcome of Minimally Invasive and Open Pancreatoduodenectomy in Patients With Intestinal and Pancreatobiliary Subtype Ampullary Cancer: An International Multicenter Cohort Study. Annals of Surgery, 283(5), 848-854. https://doi.org/10.1097/SLA.0000000000006515

@article{fb8f2c8edc90405eb074426bdc7a0c80,

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

abstract = "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.",

author = "Uijterwijk, \{Bas A.\} and Alma Moekotte and Ugo Boggi and Michele Mazzola and \{Groot Koerkamp\}, Bas and Valle, \{Raffaele Dalla\} and Alessandro Mazzotta and Misha Luyer and Geert Kazemier and Benedetto Ielpo and \{Suarez Mu{\~n}oz\}, \{Miguel Angel\} and Louisa Bolm and Bergthor Bj{\"o}rnsson and Patrick Pessaux and Jorg Kleeff and Fusai, \{Giuseppe Kito\} and Ernesto Sparrelid and Alessandro Zerbi and Lemmers, \{Dani{\"e}l H.\} and Adnan Alseidi and Miljana Vladimirov and Roberts, \{Keith J.\} and Roberto Salvia and Zahir Soonawalla and Dimitris Korkolis and Mario Serradilla-Mart{\'i}n and Mavroeidis, \{Vasileios K.\} and Bouwense, \{Stefan A.W.\} and Besselink, \{Marc G.\} and \{Abu Hilal\}, Mohammed and Laurence Webber and Laurence Webber and Ulrich Wellner and Mark Ramaekers and Poya Ghorbani and Giuseppe Malleo and Gennaro Nappo and James Halle-Smith and \{de Wilde\}, Anouk and \{de Vos Geelen\}, Judith and Karin Johansen and Kent, \{Tara S.\} and Alessandro Giani",

year = "2026",

month = may,

doi = "10.1097/SLA.0000000000006515",

language = "English",

volume = "283",

pages = "848--854",

journal = "Annals of Surgery",

issn = "0003-4932",

publisher = "Elsevier Inc.",

number = "5",

}

Uijterwijk, BA, Moekotte, A, Boggi, U, Mazzola, M, Groot Koerkamp, B, Valle, RD, Mazzotta, A, Luyer, M, Kazemier, G, Ielpo, B, Suarez Muñoz, MA, Bolm, L, Björnsson, B, Pessaux, P, Kleeff, J, Fusai, GK, Sparrelid, E, Zerbi, A, Lemmers, DH, Alseidi, A, Vladimirov, M, Roberts, KJ, Salvia, R, Soonawalla, Z, Korkolis, D, Serradilla-Martín, M, Mavroeidis, VK, Bouwense, SAW, Besselink, MG, Abu Hilal, M, Webber, L, Webber, L, Wellner, U, Ramaekers, M, Ghorbani, P, Malleo, G, Nappo, G, Halle-Smith, J, de Wilde, A, de Vos Geelen, J, Johansen, K, Kent, TS & Giani, A 2026, 'Outcome of Minimally Invasive and Open Pancreatoduodenectomy in Patients With Intestinal and Pancreatobiliary Subtype Ampullary Cancer: An International Multicenter Cohort Study', Annals of Surgery, vol. 283, no. 5, pp. 848-854. https://doi.org/10.1097/SLA.0000000000006515

Outcome of Minimally Invasive and Open Pancreatoduodenectomy in Patients With Intestinal and Pancreatobiliary Subtype Ampullary Cancer: An International Multicenter Cohort Study. / Uijterwijk, Bas A.; Moekotte, Alma; Boggi, Ugo et al.
In: Annals of Surgery, Vol. 283, No. 5, 05.2026, p. 848-854.

Research output: Journal Articles › Journal articles › Research › peer-review

TY - JOUR

T1 - Outcome of Minimally Invasive and Open Pancreatoduodenectomy in Patients With Intestinal and Pancreatobiliary Subtype Ampullary Cancer

T2 - An International Multicenter Cohort Study

AU - Uijterwijk, Bas A.

AU - Moekotte, Alma

AU - Boggi, Ugo

AU - Mazzola, Michele

AU - Groot Koerkamp, Bas

AU - Valle, Raffaele Dalla

AU - Mazzotta, Alessandro

AU - Luyer, Misha

AU - Kazemier, Geert

AU - Ielpo, Benedetto

AU - Suarez Muñoz, Miguel Angel

AU - Bolm, Louisa

AU - Björnsson, Bergthor

AU - Pessaux, Patrick

AU - Kleeff, Jorg

AU - Fusai, Giuseppe Kito

AU - Sparrelid, Ernesto

AU - Zerbi, Alessandro

AU - Lemmers, Daniël H.

AU - Alseidi, Adnan

AU - Vladimirov, Miljana

AU - Roberts, Keith J.

AU - Salvia, Roberto

AU - Soonawalla, Zahir

AU - Korkolis, Dimitris

AU - Serradilla-Martín, Mario

AU - Mavroeidis, Vasileios K.

AU - Bouwense, Stefan A.W.

AU - Besselink, Marc G.

AU - Abu Hilal, Mohammed

AU - Webber, Laurence

AU - Wellner, Ulrich

AU - Ramaekers, Mark

AU - Ghorbani, Poya

AU - Malleo, Giuseppe

AU - Nappo, Gennaro

AU - Halle-Smith, James

AU - de Wilde, Anouk

AU - de Vos Geelen, Judith

AU - Johansen, Karin

AU - Kent, Tara S.

AU - Giani, Alessandro

PY - 2026/5

Y1 - 2026/5

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/85203045716

U2 - 10.1097/SLA.0000000000006515

DO - 10.1097/SLA.0000000000006515

M3 - Journal articles

C2 - 39219532

AN - SCOPUS:85203045716

SN - 0003-4932

VL - 283

SP - 848

EP - 854

JO - Annals of Surgery

JF - Annals of Surgery

IS - 5

ER -

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

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