Minimally invasive robot-assisted and laparoscopic distal pancreatectomy in a pan-European registry a retrospective cohort study
Por:
van Bodegraven, EA, van Ramshorst, TME, Bratlie, SO, Kokkola, A, Sparrelid, E, Björnsson, B, Kleive, D, Burgdorf, SK, Dokmak, S, Koerkamp, BG, Cabús, SS, Molenaar, IQ, Boggi, U, Busch, OR, Petric, M, Roeyen, G, Hackert, T, Lips, DJ, D'Hondt, M, Coolsen, MME, Ferrari, G, Tingstedt, B, Serrablo, A, Gaujoux, S, Ramera, M, Khatkov, I, Ausania, F, Souche, R, Festen, S, Berrevoet, F, Keck, T, Sutcliffe, RP, Pando, E, de Wilde, RF, Aussilhou, B, Krohn, PS, Edwin, B, Sandström, P, Gilg, S, Seppänen, H, Vilhav, C, Abu Hilal, M, Besselink, MG
Publicada:
1 jun 2024
Resumen:
Background: International guidelines recommend monitoring 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. Patients 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 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 with LDP (9.6% vs. 16.8%, P<0.001), with longer operating time (238 vs. 201 min, 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 greater than 25 kg/m(2), 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 fewer conversions and longer operative time, including in high-risk subgroups. Future randomized trials should confirm these findings and assess cost differences.
Filiaciones:
van Bodegraven, EA:
Univ Amsterdam, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands
Canc Ctr Amsterdam, Amsterdam, Netherlands
van Ramshorst, TME:
Univ Amsterdam, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands
Canc Ctr Amsterdam, Amsterdam, Netherlands
Ist Ospedaliero Fdn Poliambulanza, Dept Gen Surg, Brescia, Italy
Bratlie, SO:
Sahlgrens Univ Hosp, Dept Surg, Gothenburg, Sweden
Kokkola, A:
Univ Helsinki, Helsinki Univ Hosp, Dept Plast Surg, Helsinki, Finland
Sparrelid, E:
Karolinska Univ Hosp, Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Surg, Stockholm, Sweden
Björnsson, B:
Linkoping Univ, Dept Surg Linkoping, Linkoping, Sweden
Linkoping Univ, Dept Biomed & Clin Sci, Linkoping, Sweden
Kleive, D:
Oslo Univ Hosp, Intervent Ctr, Dept HPB Surg, Oslo, Norway
Inst Clin Med, Oslo, Norway
Burgdorf, SK:
Copenhagen Univ Hosp, Dept Surg & Transplantat, Rigshosp, Copenhagen, Denmark
Dokmak, S:
Univ Paris Cite, APHP Beaujon Hosp, Dept HPB Surg & Liver Transplantat, Clichy, France
Koerkamp, BG:
Erasmus MC, Canc Inst, Dept Surg, Rotterdam, Netherlands
Cabús, SS:
Hosp Santa Creu I St Pau, Dept HPB Surg, Barcelona, Spain
Molenaar, IQ:
UMC Utrecht Canc Ctr, Reg Acad Canc Ctr Utrecht, Dept Surg, Utrecht, Netherlands
Univ Med Ctr Utrecht, St Antonius Hosp Nieuwegein, Utrecht, Netherlands
Boggi, U:
Univ Pisa, Div Gen & Transplant Surg, Pisa, Italy
Busch, OR:
Univ Amsterdam, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands
Canc Ctr Amsterdam, Amsterdam, Netherlands
Petric, M:
Univ Ljubljana, Med Ctr, Dept Abdominal Surg, Zaloska cesta, Ljubljana, Slovenia
Roeyen, G:
Univ Hosp Antwerp, Dept HPB Endocrine & Transplantat Surg, Edegem, Belgium
Univ Antwerp, Antwerp, Belgium
Hackert, T:
Heidelberg Univ Hosp, Dept Surg, Heidelberg, Germany
Lips, DJ:
Med Spectrum Twente, Dept Surg, Enschede, Netherlands
D'Hondt, M:
Groeninge Hosp, Dept Digest & Hepatobiliary Pancreat Surg, Kortrijk, Belgium
Coolsen, MME:
Univ Maastricht, Maastricht Univ, Dept Surg, Med Ctr, Maastricht, Netherlands
Ferrari, G:
ASST Grande Osped Metropolitano Niguarda, Div Minimally Invas Surg Oncol, Milan, Italy
Tingstedt, B:
Lund Univ, Skane Univ Hosp, Dept Surg, Clin Sci Lund, Lund, Sweden
Serrablo, A:
Miguel Servet Univ Hosp, HPB Surg Div, Zaragoza, Spain
Gaujoux, S:
Sorbonne Univ, Pitie Salpetriere Hosp, AP HP, Dept Hepatobiliary & Pancreat Surg & Liver Transpl, Paris, France
Ramera, M:
Ist Ospedaliero Fdn Poliambulanza, Dept Gen Surg, Brescia, Italy
Univ Brescia, Dept Clin & Expt Sci, Brescia, Italy
Khatkov, I:
Moscow Clin Sci Ctr, Dept Surg, Moscow, Russia
Ausania, F:
Univ Barcelona, Hosp Clin, Dept HPB & Transplant Surg, IDIBAPS, Barcelona, Spain
Souche, R:
St Eloi Hosp, Dept Surg, Montpellier, France
Festen, S:
OLVG, Dept Surg, Amsterdam, Netherlands
Berrevoet, F:
Ghent Univ Hosp, Dept Gen & HPB Surg & Liver Transplantat, Ghent, Belgium
Keck, T:
Univ Med Ctr Schleswig Holstein, Dept Surg, Campus Lubeck, Lubeck, Germany
Sutcliffe, RP:
Univ Hosp Birmingham NHS Fdn Trust, Dept Hepatopancreatobiliary Surg, Birmingham, England
Pando, E:
Hosp Universitari Vall Hebron, Dept Hepato Pancreato Biliary & Transplant Surg, Barcelona, Spain
de Wilde, RF:
Univ Paris Cite, APHP Beaujon Hosp, Dept HPB Surg & Liver Transplantat, Clichy, France
Aussilhou, B:
Copenhagen Univ Hosp, Dept Surg & Transplantat, Rigshosp, Copenhagen, Denmark
Krohn, PS:
Copenhagen Univ Hosp, Dept Surg & Transplantat, Rigshosp, Copenhagen, Denmark
Edwin, B:
Oslo Univ Hosp, Intervent Ctr, Dept HPB Surg, Oslo, Norway
Inst Clin Med, Oslo, Norway
Sandström, P:
Linkoping Univ, Dept Surg Linkoping, Linkoping, Sweden
Gilg, S:
Karolinska Univ Hosp, Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Surg, Stockholm, Sweden
Seppänen, H:
Univ Helsinki, Helsinki Univ Hosp, Dept Plast Surg, Helsinki, Finland
Vilhav, C:
Sahlgrens Univ Hosp, Dept Surg, Gothenburg, Sweden
Abu Hilal, M:
Ist Ospedaliero Fdn Poliambulanza, Dept Gen Surg, Brescia, Italy
Ist Ospedaliero Fdn Poliambulanza, Dept Hepatobiliary & Pancreat Surg, Via Leonida Bissolati,57, I-25124 Brescia, Brescia, Italy
Besselink, MG:
Univ Amsterdam, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands
Canc Ctr Amsterdam, Amsterdam, Netherlands
Univ Amsterdam, Canc Ctr Amsterdam, Amsterdam UMC, Dept Surg, De Boelelaan 1117 ZH-7F, NL-1081 HV Amsterdam, Netherlands
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