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

van Bodegraven, Eduard A ; van Ramshorst, Tess M E ; Bratlie, Svein O ; Kokkola, Arto ; Sparrelid, Ernesto ; Björnsson, Bergthor ; Kleive, Dyre ; Burgdorf, Stefan K ; Dokmak, Safi and Groot Koerkamp, Bas , et al. (2024) In International journal of surgery (London, England) 110(6). p.3554-3561
Abstract

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... (More)

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.

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Contribution to journal
publication status
published
subject
keywords
Humans, Pancreatectomy/methods, Robotic Surgical Procedures/methods, Laparoscopy/methods, Male, Female, Middle Aged, Registries, Europe, Retrospective Studies, Aged, Postoperative Complications/epidemiology, Adult
in
International journal of surgery (London, England)
volume
110
issue
6
pages
3554 - 3561
publisher
Elsevier
external identifiers
  • scopus:85197337365
  • pmid:38498397
ISSN
1743-9159
DOI
10.1097/JS9.0000000000001315
language
English
LU publication?
yes
additional info
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
id
48bd238d-3382-4ca9-8015-de9e6a80ce38
date added to LUP
2024-09-30 13:03:34
date last changed
2024-10-02 13:56:23
@article{48bd238d-3382-4ca9-8015-de9e6a80ce38,
  abstract     = {{<p>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.</p><p>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.</p><p>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 &lt;0.001). RDP was associated with fewer grade 2 intraoperative events compared with LDP (9.6% vs. 16.8%, P &lt;0.001), with longer operating time (238 vs. 201 min, P &lt;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.</p><p>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.</p>}},
  author       = {{van Bodegraven, Eduard A and van Ramshorst, Tess M E and Bratlie, Svein O and Kokkola, Arto and Sparrelid, Ernesto and Björnsson, Bergthor and Kleive, Dyre and Burgdorf, Stefan K and Dokmak, Safi and Groot Koerkamp, Bas and Cabús, Santiago Sánchez and Molenaar, I Quintus and Boggi, Ugo and Busch, Olivier R and Petrič, Miha and Roeyen, Geert and Hackert, Thilo and Lips, Daan J and D'Hondt, Mathieu and Coolsen, Mariëlle M E and Ferrari, Giovanni and Tingstedt, Bobby and Serrablo, Alejandro and Gaujoux, Sebastien and Ramera, Marco and Khatkov, Igor and Ausania, Fabio and Souche, Regis and Festen, Sebastiaan and Berrevoet, Frederik and Keck, Tobias and Sutcliffe, Robert P and Pando, Elizabeth and de Wilde, Roeland F and Aussilhou, Beatrice and Krohn, Paul S and Edwin, Bjørn and Sandström, Per and Gilg, Stefan and Seppänen, Hanna and Vilhav, Caroline and Abu Hilal, Mohammad and Besselink, Marc G}},
  issn         = {{1743-9159}},
  keywords     = {{Humans; Pancreatectomy/methods; Robotic Surgical Procedures/methods; Laparoscopy/methods; Male; Female; Middle Aged; Registries; Europe; Retrospective Studies; Aged; Postoperative Complications/epidemiology; Adult}},
  language     = {{eng}},
  month        = {{06}},
  number       = {{6}},
  pages        = {{3554--3561}},
  publisher    = {{Elsevier}},
  series       = {{International journal of surgery (London, England)}},
  title        = {{Minimally invasive robot-assisted and laparoscopic distal pancreatectomy in a pan-European registry a retrospective cohort study}},
  url          = {{http://dx.doi.org/10.1097/JS9.0000000000001315}},
  doi          = {{10.1097/JS9.0000000000001315}},
  volume       = {{110}},
  year         = {{2024}},
}