Defining Benchmark Outcomes for Pancreatoduodenectomy With Portomesenteric Venous Resection

Abstract

Objective: The aim of this study was to establish clinically relevant outcome benchmark values using criteria for pancreatoduodenectomy (PD) with portomesenteric venous resection (PVR) from a low-risk cohort managed in high-volume centers. Summary Background Data: PD with PVR is regarded as the standard of care in patients with cancer involvement of the portomesenteric venous axis. There are, however, no benchmark outcome indicators for this population which hampers comparisons of patients undergoing PD with and without PVR resection. Methods: This multicenter study analyzed patients undergoing PD with any type of PVR in 23 high-volume centers from 2009 to 2018. Nineteen outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of the centers (NCT04053998). Results: Out of 1462 patients with PD and PVR, 840 (58%) formed the benchmark cohort, with a mean age was 64 (SD11) years, 413 (49%) were females. Benchmark cutoffs, among others, were calculated as follows: Clinically relevant pancreatic fistula rate (International Study Group of Pancreatic Surgery): ≤14%; in-hospital mortality rate: ≤4%; major complication rate Grade≥3 and the CCI up to 6 months postoperatively: ≤36% and ≤26, respectively; portal vein thrombosis rate: ≤14% and 5-year survival for patients with pancreatic ductal adenocarcinoma: ≥9%. Conclusion: These novel benchmark cutoffs targeting surgical performance, morbidity, mortality, and oncological parameters show relatively inferior results in patients undergoing vascular resection because of involvement of the portomesenteric venous axis. These benchmark values however can be used to conclusively assess the results of different centers or surgeons operating on this high-risk group.

Learning Curves in Open, Laparoscopic, and Robotic Pancreatic Surgery

“…Reporting of postoperative outcomes as textbook-or benchmark outcomes facilitates international comparison. 61,74,75 The present study has a few limitations: First of all, the heterogenous definitions of the learning curve make comparisons difficult. Therefore, this study is mainly a qualitative review presenting the available data in an attempt to standardize reporting of learning curves in pancreatic surgery.…”

“…In the initial learning period, surgeons usually select low-risk patients with favorable anatomical (low BMI) and disease specific features (cystic lesions, small tumors, no vessel involvement). 47 After accumulating experience, technically more challenging and more complex cases such as advanced tumors with vascular involvement [59][60][61] or initially irresectable tumors after neoadjuvant treatment 32,62 are selected and affect the learning curve in a later stage. 58,59 Miskovic et al suggested a case selection algorithm according to disease complexity in colorectal surgery, taking into account tumor size and inflammatory disease that increased the difficulty of the surgery.…”

“…This phase of proficiency (end of second learning phase) can be defined by reaching patient centered and expert-derived benchmark-or textbook outcomes. 16,61,74 Reaching mastery (end of third learning phase), the surgeon is able to operate on more complex non-benchmark cases, for example, in pancreatic surgery advanced tumors requiring vascular resections. 58,59 Adaption to changing circumstances happens quickly and intuitively.…”

The impact of venous resection in pancreatoduodectomy

“…[ 18 ] However, partial venous resection, such as a portal vein, superior mesenteric vein, and splenic vein, are feasible, and several centers have been performing these procedures. [ 12 ]…”

Enhancing Safety in Epilepsy Surgery (EASINESS): Study Protocol for a Retrospective, Multicenter, Open Registry

“…Nevertheless, an establishment of clinical databases from international centers with an accurate collection of demographic, management, and outcome data for respective surgical procedures is needed. The importance of establishing benchmarks has been demonstrated for various surgical procedures in general and visceral surgery (11)(12)(13)(14)(15). As yet, there is very little published about acceptable neurosurgical benchmarks.…”