links.lww.com/SLA/B435

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SUPPLEMENT 1. PROPENSITY SCORE LOGISTIC REGRESSION MODEL

Odds

Ratio Std. Err. P>|t|

[95%

Conf.

Interval ]

Age 0.99 0.00 0.002 0.98 1.00

Female sex 1.26 0.11 0.007 1.07 1.49

BMI 0.98 0.01 0.028 0.96 1.00

ASA Class

ASA-1 Base

ASA-2 0.60 0.07 <.001 0.47 0.76

ASA-3 & 4 0.37 0.05 <.001 0.28 0.50

ECOG Class

ECOG 0 & 1 Base

ECOG 2 1.42 0.29 0.094 0.94 2.12

ECOG 3 & 4 0.33 0.16 0.03 0.12 0.89

Charlson Comorbidity Index 1.11 0.06 0.032 1.01 1.23 Localization and malignant suspicion

Pancreas non-malignant Base

Pancreas malignant 0.59 0.08 <.001 0.45 0.77

Periampullary/CBD non-malignant 1.32 0.30 0.22 0.85 2.06 Periampullary/CBD malignant 0.59 0.11 0.004 0.41 0.84

Duodenum non-malignant 1.87 0.56 0.036 1.04 3.36

Duodenum malignant 0.35 0.11 0.001 0.20 0.64

Other/ undetected 0.42 0.11 0.001 0.25 0.71

Multivisceral resection 0.27 0.07 <.001 0.16 0.44

Venous resection 0.80 0.12 0.129 0.60 1.07

Multivisceral involvement preop 0.65 0.16 0.083 0.40 1.06

Non-soft pancreas 1.35 0.14 0.004 1.10 1.65

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CAPTION: Number of observations 4220, global F-test 10.34 (P<0.001), AUC 0.68 (CI 0.66-0.70).

SUPPLEMENT 2. PROPENSITY SCORE DISTRIBUTION PER GROUP

CAPTION: Density (relative distribution) of propensity scores for MIPD and OPD.

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SUPPLEMENT 3. UNADJUSTED OUTCOMES AFTER LAPAROSCOPIC, ROBOT-ASSISTED, AND HYBRID PANCREATODUODENECTOMY

LPD RAPD Hybrid

n=409 n=191 n=130

Operative time, median (SD), min. 387.2 (96) 478 (111) 410.7 (114) Type of resection, No. (%)

Pylorus Preserving PD 238 (58.2) 128 (67.0) 116 (89.2)

Classic Whipple 167 (40.8) 59 (30.9) 14 (10.8)

Additional organs resected*, No. (%) 12 (2.9) 4 (2.1) 1 (.8)

Unknown 10 (2.4)

Veins resected*, No. (%) 37 (9.0) 19 (9.9) 8 (6.2)

Unknown 9 (2.2) 1 (.5)

Type of anastomosis, No. (%)

Pancreaticojejunostomy 308 (75.3) 160 (83.8) 81 (62.3)

Pancreaticogastrostomy 56 (13.7) 31 (16.2) 49 (37.7)

Other 45 (11.0)

Hard/firm pancreas 148 (36.2) 78 (40.8) 30 (23.1)

Unknown 58 (14.2) 10 (5.2) 39 (30.0)

Conversion to open surgery 105 (25.7) 10 (5.2)

Postoperative (30 days) Morbidity, No. (%)

Clavien-Dindo 0-2 (none or minor) 298 (72.9) 140 (73.3) 85 (65.4)

Clavien-Dindo 3a-4b (major) 99 (24.2) 41 (21.5) 38 (29.2)

Clavien-Dindo 5 (death) 12 (2.9) 10 (5.2) 7 (5.4)

Pancreatic fistula grade B/C, No. (%) 96 (23.6) 36 (18.8) 33 (25.4) Postpancr. hemorrhage grade B/C, No. (%) 60 (24.0) 29 (25.2) 17 (21.5) Delayed gastric emptying grade B/C, No. (%) 27 (6.6) 39 (20.5) 11 (8.7)

Reoperation, No. (%) 36 (8.8) 21 (11.0) 24 (18.5)

Length of hospital say, mean (SD), days 18 (22) 20 (16) 16 (14)

German and Dutch centers only 16 (10) 19 (14) 19 (15)

Unplanned readmission, No. (%) 44 (11.2) 6 (3.3) 19 (15.1)

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SUPPLEMENT 4. MAIN OUTCOMES AND SENSITIVITY ANALYSIS – TABLE

N

Odds Ratio

P-

Value LCI UCI 30-Day major morbidity

(Clavien-Dindo 3-5)

Unmatched 4220 0.85 0.07 0.71 1.01

PS Matched 1458 0.92 0.49 0.74 1.16

MV Adjusted* 4191 0.97 0.73 0.80 1.17

>20 MIPD p/y* 3865 0.92 0.52 0.72 1.18

Excl. first 20 MIPD* 3960 1.03 0.79 0.83 1.28

Lap + Robot PD vs OPD* 4061 0.91 0.37 0.74 1.12

Lap + Robot PD (excl. conversions) vs OPD* 3946 1.02 0.88 0.81 1.27

Robot PD vs OPD* 3659 0.89 0.51 0.63 1.26

30-Day mortality

Unmatched 4111 1.03 0.87 0.69 1.55

PS Matched 1369 1.36 0.27 0.79 2.37

MV Adjusted* 4089 1.26 0.29 0.82 1.93

>20 MIPD p/y* 3804 0.92 0.80 0.50 1.71

Excl. first 20 MIPD* 3863 1.27 0.36 0.76 2.11

Robot PD vs OPD* 3629 1.64 0.16 0.82 3.28

Grade B/C pancreatic fistula

Unmatched 4220 1.87 0.00 1.54 2.29

PS Matched 1458 2.01 0.00 1.52 2.66

MV Adjusted* 4191 2.21 0.00 1.78 2.76

>20 MIPD p/y* 3865 2.17 0.00 1.64 2.88

Excl. first 20 MIPD* 3960 2.31 0.00 1.79 2.98

Robot PD vs OPD* 3659 1.77 0.01 1.19 2.65

CAPTION: Abbreviations: c, center; Excl., excluding; LCI, lower 95% confidence interval; MV,

multivariable; p, per; UCI, upper 95% confidence interval; y, year.

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SUPPLEMENT 5. VOLUME-OUTCOME ASSOCIATION FOR MIPD

CAPTION: Volume-outcome association for (A) major morbidity (Clavien Dindo [CD] 3-5) and (B)

grade B/C postoperative pancreatic fistula (POPF) among 27 centers initially contributing data

(regardless of study in-/exclusion). Outcome rates on the Y-axis and annual volume per center on the

X-axis. Dots represent the rates, solid lines represent the fitted association, dashed lines represent

the 95% confidence intervals.

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SUPPLEMENT 6A. RISK FACTOR ANALYSIS FOR POPF IN MIPD

No POPF SD/(%) POPF SD/(%) P-Value

Baseline n=563 n=164

A

ge, mean (SD), y 64.3 (11.5) 65.3 (11.8) 0.350

B

ody-mass-index, mean (SD), kg/m2 24.6 (4.1) 26.2 (4.2) <0.001 C

harlson, median (IQR 0.5 (0.9) 0.6 (1.0) 0.279

F

emale sex, No. (%) 293 (52.0) 63 (38.4) 0.002

A SA-classification, No. (%)

A

SA 1 108 (19.2) 31 (18.9) >0.99

A

SA 2 327 (58.1) 93 (56.7) 0.788

A

SA 3-4 121 (21.5) 40 (24.4) 0.455

E COG Performance Status, No. (%)

E

COG 0-1 493 (87.6) 119 (72.6) <0.001

E

COG 2 28 (5.0) 8 (4.9) >0.99

E

COG 3-4 3 (0.5) 2 (1.2) 0.316

E

COG Unknown 39 (6.9) 35 (21.3) <0.001

Preoperative tumor characteristics

P ancreatic duct diameter in millimeters, mean (SD), mm

5 (5.7) 3.7 (2.7) 0.074

Pathology

H istology, No. (%)

A

denocarcinoma - Pancreas 265 (47.1) 40 (24.4) <0.001

A

denocarcinoma - Duodenum 9 (1.6) 5 (3.0) 0.328

A

denocarcinoma - Other 90 (16.0) 42 (25.6) 0.008

N

ET 37 (6.6) 15 (9.1) 0.300

I

PMN/ MCN 57 (10.1) 24 (14.6) 0.120

C

hronic pancreatitis 10 (1.8) 4 (2.4) 0.531

I

ntestinal adenoma 14 (2.5) 8 (4.9) 0.123

O

ther 74 (13.1) 26 (15.9) 0.370

T -stage, No. (%)

N

ot adenocarcinoma* 199 (35.3) 77 (47.0) 0.008

T 114 (20.2) 27 (16.5) 0.313

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is-T2

T

3 223 (39.6) 49 (29.9) 0.028

T

4 14 (2.5) 5 (3.0) 0.780

T

umor size, mean(SD), mm 26.1 (13.1) 25.2 (16.6) 0.562

N

-stage ≥1, No. (%) 240 (46.0) 64 (43.0) 0.576

Perioperative

O

perative time, median (SD), min. 415.5 (111.4) 415.2 (108.9) 0.974 T

ype of resection, No. (%)

P

ylorus Preserving PD 360 (63.9) 121 (73.8) 0.019

C

lassic Whipple 197 (35.0) 43 (26.2) 0.038

A

dditional organs resected*, No. (%) 12 (2.1) 3 (1.8) >0.99

V

eins resected*, No. (%) 55 (9.8) 8 (4.9) 0.058

T ype of anastomosis, No. (%)

P

ancreaticojejunostomy - non-single row 360 (63.9) 89 (54.3) 0.028 P

ancreaticogastrostomy - single row 66 (11.7) 38 (23.2) 0.001

P

ancreatogastrostomy 108 (19.2) 28 (17.1) 0.572

O

ther 29 (5.2) 9 (5.5) 0.843

S

oft Pancreatic texture 258 (53.2) 109 (79.6) <0.001

CAPTION: * Other than pancreatic head, duodenum, gallbladder, or pylorus. ** Such as porto-

mesenteric vein, superior mesenteric vein.

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SUPPLEMENT 6B. MULTIVARIABLY ADJUSTED RISK FACTORS FOR POPF IN MIPD

Covariate (n=729) Odds Ratio P-Value LCI UCI

B MI, kg/m2

1.09 <0.001 1.04 1.14 D

uct size, per mm increase

0.96 0.250 0.89 1.03 S

oft pancreatic texture

3.54 <0.001 2.18 5.75 A

ge, years

1.02 0.028 1.00 1.04 F

emale sex

0.60 0.011 0.40 0.89 H

istology

A denocarcinoma - Pancreas

Referent N

ET

2.29 0.038 1.04 5.00 I

PMN/ MCN

1.92 0.048 1.01 3.66 O

ther

2.26 <0.001 1.43 3.58 T

ype of anastomosis

P ancreatojejunostomy - non-single row

Referent P

ancreatojejunostomy - single row

2.95 <0.001 1.72 5.06 P

ancreatogastrostomy

0.76 0.308 0.44 1.29 O