1
|
Chen C, Lin X, Lin R, Yang Y, Wang C, Fang H, Huang H, Lu F. An evidence-based model for predicting conversion to open surgery in minimally invasive distal pancreatectomy. Surg Endosc 2024:10.1007/s00464-024-11216-9. [PMID: 39227440 DOI: 10.1007/s00464-024-11216-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 08/19/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND Intraoperative conversion to open surgery is an adverse event during minimally invasive distal pancreatectomy (MIDP), associated with poor postoperative outcomes. The aim of this study was to develop a model capable of predicting conversion in patients undergoing MIDP. METHODS A total of 352 patients who underwent MIPD were included in this retrospective analysis and randomly assigned to training and validation cohorts. Potential risk factors related to open conversion were identified through a literature review, and data on these factors in our cohort was collected accordingly. In the training cohort, multivariate logistic regression analysis was performed to adjust the impact of confounding factors to identify independent risk factors for model building. The constructed model was evaluated using the receiver operating characteristics curve, decision curve analysis (DCA), and calibration curves. RESULTS Following an extensive literature review, a total of ten preoperative risk factors were identified, including sex, BMI, albumin, smoker, size of lesion, tumor close to major vessels, type of pancreatic resection, surgical approach, MIDP experience, and suspicion of malignancy. Multivariate analysis revealed that sex, tumor close to major vessels, suspicion of malignancy, type of pancreatic resection (subtotal pancreatectomy or left pancreatectomy), and MIDP experience persisted as significant predictors for conversion to open surgery during MIDP. The constructed model offered superior discrimination ability compared to the existing model (area under the curve, training cohort: 0.921 vs. 0.757, P < 0.001; validation cohort: 0.834 vs. 0.716, P = 0.018). The DCA and the calibration curves revealed the clinical usefulness of the nomogram and a good consistency between the predicted and observed values. CONCLUSION The evidence-based prediction model developed in this study outperformed the previous model in predicting conversions of MIDP. This model could contribute to decision-making processes surrounding the selection of surgical approaches and facilitate patient counseling on the conversion risk of MIDP.
Collapse
Affiliation(s)
- Cong Chen
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China
| | - Xianchao Lin
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China
| | - Ronggui Lin
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China
| | - Yuanyuan Yang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China
| | - Congfei Wang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China
| | - Haizong Fang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China
| | - Heguang Huang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China.
| | - Fengchun Lu
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China.
| |
Collapse
|
2
|
Stoop TF, Augustinus S, Björnsson B, Tingstedt B, Andersson B, Wolfgang CL, Werner J, Johansen K, Stommel MWJ, Katz MHG, Ghadimi M, House MG, Ghorbani P, Molenaar IQ, de Wilde RF, Mieog JSD, Keck T, Wellner UF, Uhl W, Besselink MG, Pitt HA, Del Chiaro M. Surgical Outcome After Distal Pancreatectomy With and Without Portomesenteric Venous Resection in Patients with Pancreatic Adenocarcinoma: A Transatlantic Evaluation of Patients in North America, Germany, Sweden, and The Netherlands (GAPASURG). Ann Surg Oncol 2024:10.1245/s10434-024-15932-3. [PMID: 39120839 DOI: 10.1245/s10434-024-15932-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/16/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Pancreatic adenocarcinoma located in the pancreatic body might require a portomesenteric venous resection (PVR), but data regarding surgical risks after distal pancreatectomy (DP) with PVR are sparse. Insight into additional surgical risks of DP-PVR could support preoperative counseling and intraoperative decision making. This study aimed to provide insight into the surgical outcome of DP-PVR, including its potential risk elevation over standard DP. METHODS We conducted a retrospective, multicenter study including all patients with pancreatic adenocarcinoma who underwent DP ± PVR (2018-2020), registered in four audits for pancreatic surgery from North America, Germany, Sweden, and The Netherlands. Patients who underwent concomitant arterial and/or multivisceral resection(s) were excluded. Predictors for in-hospital/30-day major morbidity and mortality were investigated by logistic regression, correcting for each audit. RESULTS Overall, 2924 patients after DP were included, of whom 241 patients (8.2%) underwent DP-PVR. Rates of major morbidity (24% vs. 18%; p = 0.024) and post-pancreatectomy hemorrhage grade B/C (10% vs. 3%; p = 0.041) were higher after DP-PVR compared with standard DP. Mortality after DP-PVR and standard DP did not differ significantly (2% vs. 1%; p = 0.542). Predictors for major morbidity were PVR (odds ratio [OR] 1.500, 95% confidence interval [CI] 1.086-2.071) and conversion from minimally invasive to open surgery (OR 1.420, 95% CI 1.032-1.970). Predictors for mortality were higher age (OR 1.087, 95% CI 1.045-1.132), chronic obstructive pulmonary disease (OR 4.167, 95% CI 1.852-9.374), and conversion from minimally invasive to open surgery (OR 2.919, 95% CI 1.197-7.118), whereas concomitant PVR was not associated with mortality. CONCLUSIONS PVR during DP for pancreatic adenocarcinoma in the pancreatic body is associated with increased morbidity, but can be performed safely in terms of mortality.
Collapse
Affiliation(s)
- Thomas F Stoop
- Department of Surgery, Division of Surgical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam, The Netherlands.
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
| | - Simone Augustinus
- Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Bergthor Björnsson
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Bobby Tingstedt
- Department of Clinical Sciences Lund, Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Bodil Andersson
- Department of Clinical Sciences Lund, Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Christopher L Wolfgang
- Division of Surgical Oncology, Department of Surgery, New York University Medical Center, New York City, NY, USA
| | - Jens Werner
- Department of General, Visceral and Transplant Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Karin Johansen
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Martijn W J Stommel
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Matthew H G Katz
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Ghadimi
- Department of General and Visceral Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Michael G House
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Poya Ghorbani
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - I Quintus Molenaar
- Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht/St. Antonius Ziekenhuis Nieuwegein, Utrecht & Nieuwegein, The Netherlands
| | - Roeland F de Wilde
- Department of Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - J Sven D Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Tobias Keck
- DGAV StuDoQ|Pancreas and Clinic of Surgery, UKSH Campus Lübeck, Lübeck, Germany
| | - Ulrich F Wellner
- DGAV StuDoQ|Pancreas and Clinic of Surgery, UKSH Campus Lübeck, Lübeck, Germany
| | - Waldemar Uhl
- Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Marc G Besselink
- Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Henry A Pitt
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
| | - Marco Del Chiaro
- Department of Surgery, Division of Surgical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| |
Collapse
|
3
|
van Bodegraven EA, van Ramshorst TME, Bratlie SO, Kokkola A, Sparrelid E, Björnsson B, Kleive D, Burgdorf SK, Dokmak S, Groot Koerkamp B, Cabús SS, Molenaar IQ, Boggi U, Busch OR, Petrič M, Roeyen G, Hackert T, Lips DJ, D’Hondt M, Coolsen MME, Ferrari G, Tingstedt B, Serrablo A, Gaujoux S, Ramera M, Khatkov I, Ausania F, Souche R, Festen S, Berrevoet F, Keck T, Sutcliffe RP, Pando E, de Wilde RF, Aussilhou B, Krohn PS, Edwin B, Sandström P, Gilg S, Seppänen H, Vilhav C, Abu Hilal M, Besselink MG. Minimally invasive robot-assisted and laparoscopic distal pancreatectomy in a pan-European registry a retrospective cohort study. Int J Surg 2024; 110:3554-3561. [PMID: 38498397 PMCID: PMC11175778 DOI: 10.1097/js9.0000000000001315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/26/2024] [Indexed: 03/20/2024]
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 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.
Collapse
Affiliation(s)
- Eduard A. van Bodegraven
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, The Netherlands
| | - Tess M. E. van Ramshorst
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, The Netherlands
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Svein O. Bratlie
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Arto Kokkola
- Department of Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Ernesto Sparrelid
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Bergthor Björnsson
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Dyre Kleive
- Department of HPB Surgery, The Intervention Centre, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway
| | - Stefan K. Burgdorf
- Department of Surgery and Transplantation, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Safi Dokmak
- Departement of HPB Surgery and Liver Transplantation, APHP Beaujon Hospital, University of Paris Cité, Clichy, France
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - I Quintus Molenaar
- Department of Surgery, Regional Academic Cancer Centre Utrecht, UMC Utrecht Cancer Centre and St Antonius Hospital Nieuwegein, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Olivier R. Busch
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, The Netherlands
| | - Miha Petrič
- Department of Abdominal Surgery, Ljubljana University Medical Center, Zaloška cesta, Ljubljana, Slovenia
| | - Geert Roeyen
- Department of HPB, Endocrine and Transplantation Surgery, University Hospital Antwerp, Edegem, Belgium and University of Antwerp, Wilrijk, Belgium
| | - Thilo Hackert
- Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Daan J. Lips
- Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherland
| | - Mathieu D’Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Mariëlle M E Coolsen
- Department of Surgery, Maastricht University Medical Center+, University of Maastricht, Maastricht, The Netherlands
| | - Giovanni Ferrari
- Division of Minimally Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Bobby Tingstedt
- Department of Surgery, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Alejandro Serrablo
- HPB Surgical Division, Miguel Servet University Hospital, Zaragoza, Spain
| | - Sebastien Gaujoux
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Marco Ramera
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Igor Khatkov
- Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia
| | - Fabio Ausania
- Department of HPB and Transplant Surgery, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Regis Souche
- Department of Surgery, Saint-Éloi Hospital, Montpellier, France
| | | | - Frederik Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Tobias Keck
- Department of Surgery, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Robert P. Sutcliffe
- Department of Hepatopancreatobiliary Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Elizabeth Pando
- Department of Hepato, Pancreato, Biliary, and Transplant Surgery, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Roeland F. de Wilde
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Beatrice Aussilhou
- Departement of HPB Surgery and Liver Transplantation, APHP Beaujon Hospital, University of Paris Cité, Clichy, France
| | - Paul S. Krohn
- Department of Surgery and Transplantation, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Bjørn Edwin
- Department of HPB Surgery, The Intervention Centre, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway
| | - Per Sandström
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Stefan Gilg
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Seppänen
- Department of Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Caroline Vilhav
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mohammad Abu Hilal
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Marc G. Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, The Netherlands
| |
Collapse
|
4
|
Ding H, Kawka M, Gall TMH, Wadsworth C, Habib N, Nicol D, Cunningham D, Jiao LR. Robotic Distal Pancreatectomy Yields Superior Outcomes Compared to Laparoscopic Technique: A Single Surgeon Experience of 123 Consecutive Cases. Cancers (Basel) 2023; 15:5492. [PMID: 38001752 PMCID: PMC10669937 DOI: 10.3390/cancers15225492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/03/2023] [Accepted: 11/18/2023] [Indexed: 11/26/2023] Open
Abstract
Technical limitations of laparoscopic distal pancreatectomy (LDP), in comparison to robotic distal pancreatectomy (RDP), may translate to high conversion rates and morbidity. LDP and RDP procedures performed between December 2008 and January 2023 in our tertiary referral hepatobiliary and pancreatic centres were analysed and compared with regard to short-term outcomes. A total of 62 consecutive LDP cases and 61 RDP cases were performed. There was more conversion to open surgeries in the laparoscopic group compared with the robotic group (21.0% vs. 1.6%, p = 0.001). The LDP group also had a higher rate of postoperative complications (43.5% vs. 23.0%, p = 0.005). However, there was no significant difference between the two groups in terms of major complication or pancreatic fistular after operations (p = 0.20 and p = 0.71, respectively). For planned spleen-preserving operations, the RDP group had a shorter mean operative time (147 min vs. 194 min, p = 0.015) and a reduced total length of hospital stay compared with the LDP group (4 days vs. 7 days, p = 0.0002). The failure rate for spleen preservation was 0% in RDP and 20% (n = 5/25) in the LDP group (p = 0.009). RDP offered a better method for splenic preservation with Kimura's technique compared with LDP to avoid the risk of splenic infarction and gastric varices related to ligation and division of splenic pedicles. RDP should be the standard operation for the resection of pancreatic tumours at the body and tail of the pancreas without involving the celiac axis or common hepatic artery.
Collapse
Affiliation(s)
- Hao Ding
- Department of Surgery and Cancer, Imperial College London, Exhibition Road, South Kensington, London SW7 2BU, UK; (H.D.); (M.K.); (T.M.H.G.)
| | - Michal Kawka
- Department of Surgery and Cancer, Imperial College London, Exhibition Road, South Kensington, London SW7 2BU, UK; (H.D.); (M.K.); (T.M.H.G.)
| | - Tamara M. H. Gall
- Department of Surgery and Cancer, Imperial College London, Exhibition Road, South Kensington, London SW7 2BU, UK; (H.D.); (M.K.); (T.M.H.G.)
- Department of Surgery and Oncology, The Royal Marsden Hospital, 203 Fulham Road, London SW3 6JJ, UK; (D.N.); (D.C.)
| | - Chris Wadsworth
- Department of Gastroenterology and Surgery, The Hammersmith Hospital, Du Cane Road, London W12 0HS, UK; (C.W.); (N.H.)
| | - Nagy Habib
- Department of Gastroenterology and Surgery, The Hammersmith Hospital, Du Cane Road, London W12 0HS, UK; (C.W.); (N.H.)
| | - David Nicol
- Department of Surgery and Oncology, The Royal Marsden Hospital, 203 Fulham Road, London SW3 6JJ, UK; (D.N.); (D.C.)
| | - David Cunningham
- Department of Surgery and Oncology, The Royal Marsden Hospital, 203 Fulham Road, London SW3 6JJ, UK; (D.N.); (D.C.)
| | - Long R. Jiao
- Department of Surgery and Cancer, Imperial College London, Exhibition Road, South Kensington, London SW7 2BU, UK; (H.D.); (M.K.); (T.M.H.G.)
- Department of Surgery and Oncology, The Royal Marsden Hospital, 203 Fulham Road, London SW3 6JJ, UK; (D.N.); (D.C.)
| |
Collapse
|
5
|
Ausania F, Landi F, Martinie JB, Vrochides D, Walsh M, Hossain SM, White S, Prabakaran V, Melstrom LG, Fong Y, Butturini G, Bignotto L, Valle V, Bing Y, Xiu D, Di Franco G, Sanchez-Bueno F, de'Angelis N, Laurent A, Giuliani G, Pernazza G, Esposito A, Salvia R, Bazzocchi F, Esposito L, Pietrabissa A, Pugliese L, Memeo R, Uyama I, Uchida Y, Rios J, Coratti A, Morelli L, Giulianotti PC. Robotic versus laparoscopic distal pancreatectomy in obese patients. Surg Endosc 2023; 37:8384-8393. [PMID: 37715084 PMCID: PMC10615948 DOI: 10.1007/s00464-023-10361-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/30/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Although robotic distal pancreatectomy (RDP) has a lower conversion rate to open surgery and causes less blood loss than laparoscopic distal pancreatectomy (LDP), clear evidence on the impact of the surgical approach on morbidity is lacking. Prior studies have shown a higher rate of complications among obese patients undergoing pancreatectomy. The primary aim of this study is to compare short-term outcomes of RDP vs. LDP in patients with a BMI ≥ 30. METHODS In this multicenter study, all obese patients who underwent RDP or LDP for any indication between 2012 and 2022 at 18 international expert centers were included. The baseline characteristics underwent inverse probability treatment weighting to minimize allocation bias. RESULTS Of 446 patients, 219 (50.2%) patients underwent RDP. The median age was 60 years, the median BMI was 33 (31-36), and the preoperative diagnosis was ductal adenocarcinoma in 21% of cases. The conversion rate was 19.9%, the overall complication rate was 57.8%, and the 90-day mortality rate was 0.7% (3 patients). RDP was associated with a lower complication rate (OR 0.68, 95% CI 0.52-0.89; p = 0.005), less blood loss (150 vs. 200 ml; p < 0.001), fewer blood transfusion requirements (OR 0.28, 95% CI 0.15-0.50; p < 0.001) and a lower Comprehensive Complications Index (8.7 vs. 8.9, p < 0.001) than LPD. RPD had a lower conversion rate (OR 0.27, 95% CI 0.19-0.39; p < 0.001) and achieved better spleen preservation rate (OR 1.96, 95% CI 1.13-3.39; p = 0.016) than LPD. CONCLUSIONS In obese patients, RDP is associated with a lower conversion rate, fewer complications and better short-term outcomes than LPD.
Collapse
Affiliation(s)
- Fabio Ausania
- Department of HBP Surgery and Transplantation, General and Digestive Surgery, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), C. Villarroel, 170, 08036, Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Filippo Landi
- Department of HBP Surgery and Transplantation, General and Digestive Surgery, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), C. Villarroel, 170, 08036, Barcelona, Spain.
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain.
| | - John B Martinie
- Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Dionisios Vrochides
- Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Matthew Walsh
- HPB Surgery Department, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shanaz M Hossain
- HPB Surgery Department, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Laleh G Melstrom
- Division of Surgical Oncology, Gastrointestinal Disease Team, City of Hope Medical Center, Duarte, CA, USA
| | - Yuman Fong
- Division of Surgical Oncology, Gastrointestinal Disease Team, City of Hope Medical Center, Duarte, CA, USA
| | - Giovanni Butturini
- Department of HBP Surgery, P. Pederzoli Hospital, Peschiera del Garda, Italy
| | - Laura Bignotto
- Department of HBP Surgery, P. Pederzoli Hospital, Peschiera del Garda, Italy
| | - Valentina Valle
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Yuntao Bing
- Department of General Surgery, Beijing Third Hospital, Beijing, China
| | - Dianrong Xiu
- Department of General Surgery, Beijing Third Hospital, Beijing, China
| | - Gregorio Di Franco
- Division of Translational and New Technologies in Medicine and Surgery, General Surgery Department, University of Pisa, Pisa, Italy
| | | | - Nicola de'Angelis
- Department of Digestive, HBP Surgery and Liver Transplantation, Henri Mondor Hospital, APHP, Creteil, France
| | - Alexis Laurent
- Department of Digestive, HBP Surgery and Liver Transplantation, Henri Mondor Hospital, APHP, Creteil, France
| | - Giuseppe Giuliani
- Division of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
| | - Graziano Pernazza
- General and Robotic Surgery Department, San Giovanni Hospital, Rome, Italy
| | | | - Roberto Salvia
- HBP Surgery Department, Policlinico G.B. Rossi Hospital, Verona, Italy
| | - Francesca Bazzocchi
- Department of HBP Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, Foggia, Italy
| | - Ludovica Esposito
- Department of HBP Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, Foggia, Italy
| | | | - Luigi Pugliese
- Department of HBP Surgery, Policlinico S. Matteo Hospital, Pavia, Italy
| | - Riccardo Memeo
- Department of Surgery, Acquaviva delle Fonti Hospital, Bari, Italy
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yuichiro Uchida
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - José Rios
- Department of Clinical Pharmacology, Hospital Clinic and Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Andrea Coratti
- Division of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
| | - Luca Morelli
- Division of Translational and New Technologies in Medicine and Surgery, General Surgery Department, University of Pisa, Pisa, Italy
| | - Pier C Giulianotti
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
6
|
Deiro G, De Pastena M, Paiella S, Balduzzi A, Montagnini G, Andreotti E, Casetti L, Landoni L, Salvia R, Esposito A. Assessment of difficulty in laparoscopic distal pancreatectomy: A modification of the Japanese difficulty scoring system - A single-center high-volume experience. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:770-777. [PMID: 34114743 PMCID: PMC8518381 DOI: 10.1002/jhbp.1010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/22/2021] [Accepted: 05/29/2021] [Indexed: 11/13/2022]
Abstract
Background The Japanese difficulty scoring system (DSS) was developed to assess the difficulty of laparoscopic distal pancreatectomy (LDP). The study aimed to validate a modified DSS (mDSS) in a European high‐volume center. Methods Patients' clinical data underwent LDP for benign and malignant pancreatic lesion between September 2013 and February 2020 were reviewed. Expert laparoscopic surgeons performed the procedures. The mDSS consisted of seven variables, such as type of operation, malignancy, neoadjuvant therapy, pancreatic resection line, tumor close to major vessels, tumor extension to peripancreatic tissue, and left‐sided portal hypertension and/or splenomegaly. According to the difficulty level and previous score, the mDSS was subdivided into three classes: low, intermediate, and high. Surrogates of case complexity (operative time, intraoperative blood loss and blood transfusion requirements, conversion rate) were used to validate the new scoring system. Results The study population included 140 LDP. Ninety‐five (68%), 35 (25%) and 10 (7%) patients belonged to low, intermediate, and high difficulty groups. The mDSS identified the complexity of the surgical case of the series for all the surrogates of complexity considered, namely conversion rate (P = .004), operative time (P = .033) and intraoperative blood loss (P = .009). No differences were recorded in the postoperative outcomes (P > .05). Conclusion The mDSS for LDP better stratified the pancreatic procedures according to their complexity. The new scoring system may allow an appropriate preoperative evaluation of surgical difficulty, facilitating LDP's training program. Future prospective studies are needed to validate the mDSS.
Collapse
Affiliation(s)
- Giacomo Deiro
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Matteo De Pastena
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Salvatore Paiella
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Alberto Balduzzi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Greta Montagnini
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Elena Andreotti
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Luca Casetti
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Luca Landoni
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Roberto Salvia
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Alessandro Esposito
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| |
Collapse
|