Minimally invasive versus open distal pancreatectomy: a matched analysis using ACS-NSQIP

Adams, Alexandra; Russell, Dylan; Carpenter, Elizabeth L.; Nelson, Daniel W.; Yheulon, Christopher G.; Vreeland, Timothy J.

doi:10.1007/s00464-022-09363-y

Cited by 9 publications

(5 citation statements)

References 17 publications

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“…Several retrospective studies and two randomised trials demonstrated short-term benefits in terms of functional recovery and hospital stay after MIDP over ODP for all indications. 6 , 7 , 8 However, concerns remain regarding the oncological safety of MIDP in patients with resectable pancreatic cancer. Those concerns were highlighted by an international survey study wherein one-third of pancreatic surgeons expected inferior oncological outcomes after MIDP for pancreatic cancer.…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive versus open distal pancreatectomy for resectable pancreatic cancer (DIPLOMA): an international randomised non-inferiority trial

Korrel,

Jones,

van Hilst

et al. 2023

The Lancet Regional Health - Europe

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Section: Introductionmentioning

confidence: 99%

Minimally invasive versus open distal pancreatectomy for resectable pancreatic cancer (DIPLOMA): an international randomised non-inferiority trial

Korrel,

Jones,

van Hilst

et al. 2023

The Lancet Regional Health - Europe

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“…The lack of external validity of randomized trials was recently demonstrated by a study in minimally invasive esophagectomy, as outcomes of the randomized trial could not be confirmed on a nationwide level 32 . For MIDP, outcomes of the previous LEOPARD and LAPOP randomized trials have now been confirmed by the present study and a recent NSQIP database study in 3940 patients 12,13,33 . To safeguard and facilitate further implementation of MIDP, the recent International Guidelines on Minimally Invasive Pancreatic Resection 29 and a recent Delphi consensus study, advise the use of structured training programs 34 …”

Section: Discussionmentioning

confidence: 68%

“…32 For MIDP, outcomes of the previous LEOPARD and LAPOP randomized trials have now been confirmed by the present study and a recent NSQIP database study in 3940 patients. 12,13,33 To safeguard and facilitate further implementation of MIDP, the recent International Guidelines on Minimally Invasive Pancreatic Resection 29 and a recent Delphi consensus study, advise the use of structured training programs. 34 Despite the significantly higher rate of grade B/C POPF after MIDP, the rate of (radiological) reinterventions after MIDP and ODP was comparable in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…It will be interesting to see how a no-drain policy as previously studied 36 and currently studied in the multicenter PANDORINA trial 37 will influence the rate of POPF after MIDP. Other potential explanations could be the difference in pancreatic transection technique between MIDP and ODP (as suggested by the authors of the NSQIP manuscript 33 ) and the difference in assessment of pancreatic texture between MIDP and ODP. Theoretically, the difference in histopathological diagnoses (less pancreatic cancer and more intraductal papillary mucinous neoplasms) could have lead to more soft pancreas specimens in the MIDP group, but this was not observed in the present study.…”

Section: Discussionmentioning

confidence: 99%

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Nationwide use and outcome of Minimally Invasive Distal Pancreatectomy in IDEAL Stage IV following a Training Program and Randomized Trial

et al. 2023

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Objective: To assess the nationwide long-term uptake and outcomes of minimally invasive distal pancreatectomy (MIDP) after a nationwide training program and randomized trial. Background: Two randomized trials demonstrated the superiority of MIDP over open distal pancreatectomy (ODP) in terms of functional recovery and hospital stay. Data on implementation of MIDP on a nationwide level are lacking. Methods: Nationwide audit-based study including consecutive patients after MIDP and ODP in 16 centers in the Dutch Pancreatic Cancer Audit (2014 to 2021). The cohort was divided into three periods: early implementation, during the LEOPARD randomized trial, and late implementation. Primary endpoints were MIDP implementation rate and textbook outcome. Results: Overall, 1496 patients were included with 848 MIDP (56.5%) and 648 ODP (43.5%). From the early to the late implementation period, the use of MIDP increased from 48.6% to 63.0% and of robotic MIDP from 5.5% to 29.7% (P < 0.001). The overall use of MIDP (45% to 75%) and robotic MIDP (1% to 84%) varied widely between centers (P < 0.001). In the late implementation period, 5/16 centers performed > 75% of procedures as MIDP. After MIDP, in-hospital mortality and textbook outcome remained stable over time. In the late implementation period, ODP was more often performed in ASA score III-IV (24.9% vs. 35.7%, P = 0.001), pancreatic cancer (24.2% vs. 45.9%, P < 0.001), vascular involvement (4.6% vs. 21.9%, P < 0.001), and multivisceral involvement (10.5% vs. 25.3%, P < 0.001). After MIDP, shorter hospital stay (median 7 vs. 8 d, P < 0.001) and less blood loss (median 150 vs. 500 mL, P < 0.001), but more grade B/C postoperative pancreatic fistula (24.4% vs. 17.2%, P = 0.008) occurred as compared to ODP. Conclusion: A sustained nationwide implementation of MIDP after a successful training program and randomized trial was obtained with satisfactory outcomes. Future studies should assess the considerable variation in the use of MIDP between centers and, especially, robotic MIDP.

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“…The outcomes of our study can be compared with other registries for pancreatic surgery, especially the National Surgical Quality Improvement Program (NSQIP) in North America which reported 8.6% major morbidity, 12.5% POPF grade B/C, 2.7% reoperation, 0.7% 30-day mortality, and 17.4% readmission in 1978 patients after MIDP 21 . These outcomes are largely consistent with the outcomes of this study, although the current study reported higher POPF and major morbidity rates.…”

Section: Discussionmentioning

confidence: 93%

Minimally invasive robot-assisted and laparoscopic distal pancreatectomy in a pan-European registry a retrospective cohort study

van Bodegraven,

van Ramshorst,

Bratlie

et al. 2024

International Journal of Surgery

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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.

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Minimally invasive versus open distal pancreatectomy: a matched analysis using ACS-NSQIP

Cited by 9 publications

References 17 publications

Minimally invasive versus open distal pancreatectomy for resectable pancreatic cancer (DIPLOMA): an international randomised non-inferiority trial

Minimally invasive versus open distal pancreatectomy for resectable pancreatic cancer (DIPLOMA): an international randomised non-inferiority trial

Nationwide use and outcome of Minimally Invasive Distal Pancreatectomy in IDEAL Stage IV following a Training Program and Randomized Trial

Minimally invasive robot-assisted and laparoscopic distal pancreatectomy in a pan-European registry a retrospective cohort study

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