The PD-ROBOSCORE: A difficulty score for robotic pancreatoduodenectomy

Napoli, Niccolò; Cacace, Concetta; Kauffmann, Emanuele Federico; Jones, Larry G.; Ginesini, Michael; Gianfaldoni, Cesare; Salamone, Alice; Asta, Fabio; Ripolli, Allegra; Dato, Armando Di; Busch, Olivier R.; Cappelle, Marie; Chao, Yei-Chin; Wilde, Roeland F. de; Hackert, Thilo; Jang, Jin‐Young; Koerkamp, B. Groot; Kwon, Wooil; Lips, Daan J.; Luyer, Misha; Nickel, Felix; Saint‐Marc, Olivier; Shan, Yan–Shen; Shen, Baiyong; Vistoli, Fabio; Besselink, Marc G.; Hilal, Mohammad Abu; Boggi, Ugo

doi:10.1016/j.surg.2023.02.020

Cited by 10 publications

(3 citation statements)

References 56 publications

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“…In this score, 2 of the 5 difficulty parameters have clear implications for PD-VR (ie, borderline resectable pancreatic tumor and tumor located in the uncinate process of the pancreas). 40 Therefore, it is important to note that robotic PD-VR did not increase the incidence of SPC compared to open PD-VR.…”

Section: Discussionmentioning

confidence: 94%

Robotic Versus Open Pancreatoduodenectomy With Vein Resection and Reconstruction: A Propensity Score-Matched Analysis

Napoli,

Kauffmann,

Ginesini

et al. 2024

Annals of Surgery Open

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Objective: This study aimed to compare robotic pancreatoduodenectomy with vein resection (PD-VR) based on the incidence of severe postoperative complications (SPC). Background: Robotic pancreatoduodenectomy has been gaining momentum in recent years. Vein resection is frequently required in this operation, but no study has compared robotic and open PD-VR using a matched analysis. Methods: This was an intention-to-treat study designed to demonstrate the noninferiority of robotic to open PD-VR (2011–2021) based on SPC. To achieve a power of 80% (noninferiority margin:10%; α error: 0.05; ß error: 0.20), a 1:1 propensity score-matched analysis required 35 pairs. Results: Of the 151 patients with PD-VR (open = 115, robotic = 36), 35 procedures per group were compared. Elective conversion to open surgery was required in 1 patient with robotic PD-VR (2.9%). One patient in both groups experienced partial vein thrombosis. SPC occurred in 7 (20.0%) and 6 patients (17.1%) in the robotic and open PD-VR groups, respectively (P = 0.759; OR: 1.21 [0.36–4.04]). Three patients died after robotic PD-VR (8.6%) and none died after open PD-VR (P = 0.239). Robotic PD-VR was associated with longer operative time (611.1 ± 13.9 minutes vs 529.0 ± 13.0 minutes; P < 0.0001), more type 2 vein resection (28.6% vs 5.7%; P = 0.0234) and less type 3 vein resection (31.4% vs 71.4%; P = 0.0008), longer vein occlusion time (30 [25.3–78.3] minutes vs 15 [8–19.5] minutes; P = 0.0098), less blood loss (450 [200–750] mL vs 733 [500–1070.3] mL; P = 0.0075), and fewer blood transfusions (intraoperative: 14.3% vs 48.6%; P = 0.0041) (perioperative: 14.3% vs 60.0%; P = 0.0001). Conclusions: In this study, robotic PD-VR was noninferior to open PD-VR for SPC. Robotic and open PD-VR need to be compared in randomized controlled trials.

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Section: Discussionmentioning

confidence: 94%

Robotic Versus Open Pancreatoduodenectomy With Vein Resection and Reconstruction: A Propensity Score-Matched Analysis

Napoli,

Kauffmann,

Ginesini

et al. 2024

Annals of Surgery Open

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“…This may be operationalized by devising strict national and international surgical society guidelines. Further, utilization of risk prediction scores like Difficulty scoring system (DSS)[ 49 ] or PD-ROBOSCORE [ 50 ] will likely aid better patient selection for MIPD.…”

Section: Discussionmentioning

confidence: 99%

Impact of Unplanned Intra‐Operative Conversions on Outcomes in Minimally Invasive Pancreatoduodenectomy

et al. 2023

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Background Minimally-invasive pancreatoduodenectomy (MIPD) is fraught with the risk of complication-related deaths (LEOPARD-2), a significant volume-outcome relationship and a long learning curve. With rates of conversion for MIPD approaching 40%, the impact of these on overall patient outcomes, especially, when unplanned, are yet to be fully elucidated. This study aimed to compare peri-operative outcomes of (unplanned) converted MIPD against both successfully completed MIPD and upfront open PD. Methods A systematic review of major reference databases was undertaken. The primary outcome of interest was 30-day mortality. Newcastle–Ottawa scale was used to judge the quality of the studies. Meta-analysis was performed using pooled estimates, derived using random effects model. Results Six studies involving 20,267 patients were included in the review. Pooled analysis demonstrated (unplanned) converted MIPD were associated with an increased 30-day (RR 2.83, CI 1.62- 4.93, p = 0.0002, I2 = 0%) and 90-day (RR 1.81, CI 1.16- 2.82, p = 0.009, I2 = 28%) mortality and overall morbidity (RR 1.41, CI 1.09; 1.82, p = 0.0087, I2 = 82%) compared to successfully completed MIPD. Patients undergoing (unplanned) converted MIPD experienced significantly higher 30-day mortality (RR 3.97, CI 2.07; 7.65, p < 0.0001, I2 = 0%), pancreatic fistula (RR 1.65, CI 1.22- 2.23, p = 0.001, I2 = 0%) and re-exploration rates (RR 1.96, CI 1.17- 3.28, p = 0.01, I2 = 37%) compared upfront open PD. Conclusions Patient outcomes are significantly compromised following unplanned intraoperative conversions of MIPD when compared to successfully completed MIPD and upfront open PD. These findings stress the need for objective evidence-based guidelines for patient selection for MIPD.

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“… 1 Several retrospective studies have demonstrated that robotic pancreatoduodenectomy (RPD) may be comparable to open PD (OPD), although the criteria for patient selection remain contentious. 2 , 3 Furthermore, while approximately 40 RPD cases are needed to overcome the initial learning curve, the full potential of RPD may not be realized until 250 procedures. 4 The importance of achieving proficiency in minimally invasive pancreatoduodenectomy before implementing randomised controlled trials (RCTs) was highlighted by the LEOPARD-2 trial, which was closed due to safety concerns.…”

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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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The PD-ROBOSCORE: A difficulty score for robotic pancreatoduodenectomy

Cited by 10 publications

References 56 publications

Robotic Versus Open Pancreatoduodenectomy With Vein Resection and Reconstruction: A Propensity Score-Matched Analysis

Robotic Versus Open Pancreatoduodenectomy With Vein Resection and Reconstruction: A Propensity Score-Matched Analysis

Impact of Unplanned Intra‐Operative Conversions on Outcomes in Minimally Invasive Pancreatoduodenectomy

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

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