5.

Differential outcomes in USA, Europe and China

Country/ Region	Time MIPD initiated	MIPD volume for pancreatic head cancer	Number of studies	Advantages	Disadvantages
MIPD, minimally invasive pancreaticoduodenectomy; NCDB, American National Cancer Database; LPD, laparoscopic pancreaticoduodenectomy; OPD, open pancreaticoduodenectomy.
USA	20th century, the earliest	>3,700	14	1. Surgeons in USA are proficient at MIPD 2. NCDB, multicenter data on MIPD 3. Complete data on neoadjuvant therapy	Lack of surgical safety data
Europe	Later than USA	Approximately 1,000	4	1. Pan-European multicenter studies 2. The first report of a multicenter training program in LPD	1. Restrict indications for MIPD 2. The definition of high-volume center is unreasonable
China	2002	<1,000	5	1. The first expert consensus on LPD 2. R0 resection rate is higher than that of other countries	1. Lack of OPD control group 2. Lack of data on survival and neoadjuvant therapy 3. Lack of multicenter study