Robotic versus open partial pancreatoduodenectomy (EUROPA): a randomised controlled stage 2b trial

Klotz, Rosa; Mihaljevic, André L.; Kulu, Yakup; Sander, Anja; Klose, Christina; Behnisch, Rouven; Joos, Maximilian C.; Kalkum, Eva; Nickel, Felix; Knebel, Phillip; Pianka, Frank; Diener, Markus K.; Büchler, Markus W.; Hackert, Thilo

doi:10.1016/j.lanepe.2024.100864

Cited by 15 publications

(2 citation statements)

References 42 publications

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“…If patients experience less complications and therefore have a shorter hospital stay, the robotic approach is cost effective. [ 25 – 27 ] Given the higher rate of interstage discharge and a 3-day difference in length of stay, we assume cost effectiveness of the robotic approach even with the longer operation time in this cohort.…”

Section: Discussionmentioning

confidence: 99%

Full robotic versus open ALPPS: a bi-institutional comparison of perioperative outcomes

Guidetti,

Müller,

Magistri

et al. 2024

Surg Endosc

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Background In primarily unresectable liver tumors, ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy) may offer curative two-stage hepatectomy trough a fast and extensive hypertrophy. However, concerns have been raised about the invasiveness of the procedure. Full robotic ALPPS has the potential to reduce the postoperative morbidity trough a less invasive access. The aim of this study was to compare the perioperative outcomes of open and full robotic ALPPS. Methods The bicentric study included open ALPPS cases from the University Hospital Zurich, Switzerland and robotic ALPPS cases from the University of Modena and Reggio Emilia, Italy from 01/2015 to 07/2022. Main outcomes were intraoperative parameters and overall complications. Results Open and full robotic ALPPS were performed in 36 and 7 cases. Robotic ALPPS was associated with less blood loss after both stages (418 ± 237 ml vs. 319 ± 197 ml; P = 0.04 and 631 ± 354 ml vs. 258 ± 53 ml; P = 0.01) as well as a higher rate of interstage discharge (86% vs. 37%; P = 0.02). OT was longer with robotic ALPPS after both stages (371 ± 70 min vs. 449 ± 81 min; P = 0.01 and 282 ± 87 min vs. 373 ± 90 min; P = 0.02). After ALPPS stage 2, there was no difference for overall complications (86% vs. 86%; P = 1.00) and major complications (43% vs. 39%; P = 0.86). The total length of hospital stay was similar (23 ± 17 days vs. 26 ± 13; P = 0.56). Conclusion Robotic ALPPS was safely implemented and showed potential for improved perioperative outcomes compared to open ALPPS in an experienced robotic center. The robotic approach might bring the perioperative risk profile of ALPPS closer to interventional techniques of portal vein embolization/liver venous deprivation.

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Section: Discussionmentioning

confidence: 99%

Full robotic versus open ALPPS: a bi-institutional comparison of perioperative outcomes

Guidetti,

Müller,

Magistri

et al. 2024

Surg Endosc

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“…In recent weeks, results from two RCTs comparing RPD with OPD have been published, one from Heidelberg (EUROPA trial) and the other from China. 6 , 7 Notably, a US-based RCT (trial registry: NCT04171440) could not be completed due to difficulties in recruiting patients for OPD and was “converted” into an observational study on perioperative outcomes of RPD. While patients' choices cannot dictate scientific evidence, it is noteworthy that the EUROPA trial saw 12% of patients declining participation, while 21% did so in the Chinese trial.…”

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confidence: 99%

Disentangling seemingly contradictory results of the first two randomised controlled trials comparing open and robotic pancreatoduodenectomy

Boggi,

Napoli,

Kauffmann

2024

The Lancet Regional Health - Europe

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Effects of Pancreatic Fistula After Minimally Invasive and Open Pancreatoduodenectomy

Bruna,

Emmen,

Wei

et al. 2024

JAMA Surg

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ImportancePostoperative pancreatic fistulas (POPF) are the biggest contributor to surgical morbidity and mortality after pancreatoduodenectomy. The impact of POPF could be influenced by the surgical approach.ObjectiveTo assess the clinical impact of POPF in patients undergoing minimally invasive pancreatoduodenectomy (MIPD) and open pancreatoduodenectomy (OPD).Design, Setting, and ParticipantsThis cohort study was conducted from 2007 to 2020 in 36 referral centers in Europe, South America, and Asia. Participants were patients with POPF (grade B/C as defined by the International Study Group of Pancreatic Surgery [ISGPS]) after MIPD and OPD (MIPD-POPF, OPD-POPF). Propensity score matching was performed in a 1:1 ratio based on the variables age (continuous), sex, body mass index (continuous), American Society of Anesthesiologists score (dichotomous), vascular involvement, neoadjuvant therapy, tumor size, malignancy, and POPF grade C. Data analysis was performed from July to October 2023.ExposureMIPD and OPD.Main Outcomes and MeasuresThe primary outcome was the presence of a second clinically relevant (ISGPS grade B/C) complication (postpancreatic hemorrhage [PPH], delayed gastric emptying [DGE], bile leak, and chyle leak) besides POPF.ResultsOverall, 1130 patients with POPF were included (558 MIPD and 572 OPD), of whom 336 patients after MIPD were matched to 336 patients after OPD. The median (IQR) age was 65 (58-73) years; there were 703 males (62.2%) and 427 females (37.8%). Among patients who had MIPD-POPF, 129 patients (55%) experienced a second complication compared with 95 patients (36%) with OPD-POPF (P &lt; .001). The rate of PPH was higher with MIPD-POPF (71 patients [21%] vs 22 patients [8.0%]; P &lt; .001), without significant differences for DGE (65 patients [19%] vs 45 patients [16%]; P = .40), bile leak (43 patients [13%] vs 52 patients [19%]; P = .06), and chyle leak (1 patient [0.5%] vs 5 patients [1.9%]; P = .39). MIPD-POPF was associated with a longer hospital stay (median [IQR], 27 [18-38] days vs 22 [15-30] days; P &lt; .001) and more reoperations (67 patients [21%] vs 21 patients [7%]; P &lt; .001) but comparable in-hospital/30-day mortality (25 patients [7%] vs 7 patients [5%]; P = .31) with OPD-POPF, respectively.Conclusions and RelevanceThis study found that for patients after MIPD, the presence of POPF is more frequently associated with other clinically relevant complications compared with OPD. This underscores the importance of perioperative mitigation strategies for POPF and the resulting PPH in high-risk patients.

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Robotic versus open partial pancreatoduodenectomy (EUROPA): a randomised controlled stage 2b trial

Cited by 15 publications

References 42 publications

Full robotic versus open ALPPS: a bi-institutional comparison of perioperative outcomes

Full robotic versus open ALPPS: a bi-institutional comparison of perioperative outcomes

Disentangling seemingly contradictory results of the first two randomised controlled trials comparing open and robotic pancreatoduodenectomy

Effects of Pancreatic Fistula After Minimally Invasive and Open Pancreatoduodenectomy

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