Minimally invasive robot-assisted and laparoscopic distal pancreatectomy in a pan-European registry a retrospective cohort study
van Bodegraven, Eduard A. (Cancer Center Amsterdam)
van Ramshorst, Tess M.E. (Istituto Ospedaliero Fondazione Poliambulanza)
Bratlie, Svein O. (Sahlgrenska University Hospital (Suècia))
Kokkola, Arto (Helsinki University Hospital)
Sparrelid, Ernesto (Karolinska University Hospital)
Björnsson, Bergthor (Linköping University. Linköping)
Kleive, Dyre (Oslo University Hospital and Institute for Clinical Medicine)
Burgdorf, Stefan K. (Rigshospitalet Copenhagen University Hospital)
Dokmak, Safi (University of Paris Cité)
Groot Koerkamp, Bas (Erasmus MC Cancer Institute)
Sánchez-Cabús, Santiago (Institut de Recerca Sant Pau)
Molenaar, I Quintus (University Medical Centre Utrecht)
Boggi, Ugo (Division of General and Transplant Surgery. University of Pisa)
Busch, Olivier R. (Cancer Center Amsterdam)
Petrič, Miha (Department of Abdominal Surgery. Ljubljana University Medical Center)
Roeyen, Geert (Belgium and University of Antwerp)
Hackert, Thilo (Heidelberg University Hospital (Alemanya))
Lips, Daan J. (Medisch Spectrum Twente)
D'Hondt, Mathieu (Groeninge Hospital)
Coolsen, Mariëlle M.E. (University of Maastricht)
Ferrari, Giovanni (ASST Grande Ospedale Metropolitano Niguarda)
Tingstedt, Bobby (Lund University)
Serrablo, Alejandro (HPB Surgical Division)
Gaujoux, Sebastien (Sorbonne University)
Ramera, Marco (University of Brescia)
Khatkov, Igor (Moscow Clinical Scientific Center)
Ausania, Fabio (Hospital Clínic i Provincial de Barcelona)
Souche, Regis (Saint-Éloi Hospital)
Festen, Sebastiaan (OLVG)
Berrevoet, Frederik (Universitair Ziekenhuis Gent)
Keck, Tobias (University Medical Centre Schleswig-Holstein)
Sutcliffe, Robert P. (Birmingham Women's and Children's Hospital (Regne Unit))
Pando, Elizabeth (Hospital Universitari Vall d'Hebron)
de Wilde, Roeland F. (Erasmus MC Cancer Institute)
Aussilhou, Beatrice (University of Paris Cité)
Krohn, Paul S. (Rigshospitalet Copenhagen University Hospital)
Edwin, Bjørn (Oslo University Hospital and Institute for Clinical Medicine)
Sandström, Per (Linköping University. Linköping)
Gilg, Stefan (Karolinska University Hospital)
Seppänen, Hanna (Helsinki University Hospital)
Vilhav, Caroline (Sahlgrenska University Hospital (Suècia))
Abu Hilal, Mohammad (Istituto Ospedaliero Fondazione Poliambulanza)
Besselink, Marc G. (Cancer Center Amsterdam)
Universitat Autònoma de Barcelona

Data:	2024
Resum:	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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Adult ; Aged ; Europe ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Pancreatectomy ; Postoperative Complications ; Registries ; Retrospective Studies ; Robotic Surgical Procedures
Publicat a:	International journal of surgery, Vol. 110 Núm. 6 (january 2024) , p. 3554-3561, ISSN 1743-9159

DOI: 10.1097/JS9.0000000000001315
PMID: 38498397

8 p, 339.9 KB

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