TY - JOUR
T1 - Minimally invasive robot-assisted and laparoscopic distal pancreatectomy in a pan-European registry a retrospective cohort study
AU - van Bodegraven, Eduard A
AU - van Ramshorst, Tess M E
AU - Bratlie, Svein O
AU - Kokkola, Arto
AU - Sparrelid, Ernesto
AU - Björnsson, Bergthor
AU - Kleive, Dyre
AU - Burgdorf, Stefan K
AU - Dokmak, Safi
AU - Groot Koerkamp, Bas
AU - Cabús, Santiago Sánchez
AU - Molenaar, I Quintus
AU - Boggi, Ugo
AU - Busch, Olivier R
AU - Petric, Miha
AU - Roeyen, Geert
AU - Hackert, Thilo
AU - Lips, Daan J
AU - D'Hondt, Mathieu
AU - Coolsen, Mariëlle M E
AU - Ferrari, Giovanni
AU - Tingstedt, Bobby
AU - Serrablo, Alejandro
AU - Gaujoux, Sebastien
AU - Ramera, Marco
AU - Khatkov, Igor
AU - Ausania, Fabio
AU - Souche, Regis
AU - Festen, Sebastiaan
AU - Berrevoet, Frederik
AU - Keck, Tobias
AU - Sutcliffe, Robert P
AU - Pando, Elizabeth
AU - de Wilde, Roeland F
AU - Aussilhou, Beatrice
AU - Krohn, Paul S
AU - Edwin, Bjørn
AU - Sandström, Per
AU - Gilg, Stefan
AU - Seppänen, Hanna
AU - Vilhav, Caroline
AU - Abu Hilal, Mohammad
AU - Besselink, Marc G
AU - European Consortium on Minimally Invasive Pancreatic Surgery (E- MIPS)
PY - 2024/3/18
Y1 - 2024/3/18
N2 - BACKGROUND: International guidelines recommend monitoring of the use and outcome of minimally invasive pancreatic surgery (MIPS). However, data from prospective international audits on minimally invasive distal pancreatectomy (MIDP) are lacking. This study examined the use and outcome of robot-assisted (RDP) and laparoscopic (LDP) distal pancreatectomy in the E-MIPS registry. MATERIALS AND METHODS: Post-hoc analysis in a prospective audit on MIPS, including consecutive patients undergoing MIDP in 83 centers from 19 European countries (01-01-2019/31-12-2021). Primary outcomes included intraoperative events (grade 1: excessive blood loss, grade 2: conversion/change in operation, grade 3: intraoperative death), major morbidity, and in-hospital/30-day mortality. Multivariable logistic regression analyses identified high-risk groups for intraoperative events. RDP and LDP were compared in the total cohort and in high-risk groups. RESULTS: Overall, 1672 patients undergoing MIDP were included; 606 (36.2%) RDP and 1066 (63.8%) LDP. The annual use of RDP increased from 30.5% to 42.6% (P<0.001). RDP was associated with fewer grade 2 intraoperative events compared to LDP (9.6% vs. 16.8%, P<0.001), with longer operating time (238 vs. 201 minutes,P<0.001). No significant differences were observed between RDP and LDP regarding major morbidity (23.4% vs. 25.9%, P=0.264) and in-hospital/30-day mortality (0.3% vs. 0.8%, P=0.344). Three high-risk groups were identified; BMI>25 kg/m2, previous abdominal surgery, and vascular involvement. In each group, RDP was associated with fewer conversions and longer operative times. CONCLUSION: This European registry-based study demonstrated favorable outcomes for MIDP, with mortality rates below 1%. LDP remains the predominant approach, whereas the use of RDP is increasing. RDP was associated with less conversions and longer operative time, including in high-risk subgroups. Future randomized trials should confirm these findings and assess cost differences.
AB - BACKGROUND: International guidelines recommend monitoring of the use and outcome of minimally invasive pancreatic surgery (MIPS). However, data from prospective international audits on minimally invasive distal pancreatectomy (MIDP) are lacking. This study examined the use and outcome of robot-assisted (RDP) and laparoscopic (LDP) distal pancreatectomy in the E-MIPS registry. MATERIALS AND METHODS: Post-hoc analysis in a prospective audit on MIPS, including consecutive patients undergoing MIDP in 83 centers from 19 European countries (01-01-2019/31-12-2021). Primary outcomes included intraoperative events (grade 1: excessive blood loss, grade 2: conversion/change in operation, grade 3: intraoperative death), major morbidity, and in-hospital/30-day mortality. Multivariable logistic regression analyses identified high-risk groups for intraoperative events. RDP and LDP were compared in the total cohort and in high-risk groups. RESULTS: Overall, 1672 patients undergoing MIDP were included; 606 (36.2%) RDP and 1066 (63.8%) LDP. The annual use of RDP increased from 30.5% to 42.6% (P<0.001). RDP was associated with fewer grade 2 intraoperative events compared to LDP (9.6% vs. 16.8%, P<0.001), with longer operating time (238 vs. 201 minutes,P<0.001). No significant differences were observed between RDP and LDP regarding major morbidity (23.4% vs. 25.9%, P=0.264) and in-hospital/30-day mortality (0.3% vs. 0.8%, P=0.344). Three high-risk groups were identified; BMI>25 kg/m2, previous abdominal surgery, and vascular involvement. In each group, RDP was associated with fewer conversions and longer operative times. CONCLUSION: This European registry-based study demonstrated favorable outcomes for MIDP, with mortality rates below 1%. LDP remains the predominant approach, whereas the use of RDP is increasing. RDP was associated with less conversions and longer operative time, including in high-risk subgroups. Future randomized trials should confirm these findings and assess cost differences.
U2 - 10.1097/JS9.0000000000001315
DO - 10.1097/JS9.0000000000001315
M3 - Article
SN - 1743-9159
JO - International journal of surgery (London, England)
JF - International journal of surgery (London, England)
ER -