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Abu Hilal M, van Ramshorst TM, Boggi U, Dokmak S, Edwin B, Keck T, Khatkov I, Ahmad J, Al Saati H, Alseidi A, Azagra JS, Björnsson B, Can FM, D’Hondt M, Efanov M, Espin Alvarez F, Esposito A, Ferrari G, Groot Koerkamp B, Gumbs AA, Hogg ME, Huscher CG, Ielpo B, Ivanecz A, Jang JY, Liu R, Luyer MD, Menon K, Nakamura M, Piardi T, Saint-Marc O, White S, Yoon YS, Zerbi A, Bassi C, Berrevoet F, Chan C, Coimbra FJ, Conlon KC, Cook A, Dervenis C, Falconi M, Ferrari C, Frigerio I, Fusai GK, De Oliveira ML, Pinna AD, Primrose JN, Sauvanet A, Serrablo A, Smadi S, Badran A, Baychorov M, Bannone E, van Bodegraven EA, Emmen AM, Giani A, de Graaf N, van Hilst J, Jones LR, Levi Sandri GB, Pulvirenti A, Ramera M, Rashidian N, Sahakyan MA, Uijterwijk BA, Zampedri P, Zwart MJ, Alfieri S, Berti S, Butturini G, Di Benedetto F, Ettorre GM, Giuliante F, Jovine E, Memeo R, Portolani N, Ruzzenente A, Salvia R, Siriwardena AK, Besselink MG, Asbun HJ. The Brescia Internationally Validated European Guidelines on Minimally Invasive Pancreatic Surgery (EGUMIPS). Ann Surg 2024; 279:45-57. [PMID: 37450702 PMCID: PMC10727198 DOI: 10.1097/sla.0000000000006006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To develop and update evidence-based and consensus-based guidelines on laparoscopic and robotic pancreatic surgery. SUMMARY BACKGROUND DATA Minimally invasive pancreatic surgery (MIPS), including laparoscopic and robotic surgery, is complex and technically demanding. Minimizing the risk for patients requires stringent, evidence-based guidelines. Since the International Miami Guidelines on MIPS in 2019, new developments and key publications have been reported, necessitating an update. METHODS Evidence-based guidelines on 22 topics in 8 domains were proposed: terminology, indications, patients, procedures, surgical techniques and instrumentation, assessment tools, implementation and training, and artificial intelligence. The Brescia Internationally Validated European Guidelines on Minimally Invasive Pancreatic Surgery (EGUMIPS, September 2022) used the Scottish Intercollegiate Guidelines Network (SIGN) methodology to assess the evidence and develop guideline recommendations, the Delphi method to establish consensus on the recommendations among the Expert Committee, and the AGREE II-GRS tool for guideline quality assessment and external validation by a Validation Committee. RESULTS Overall, 27 European experts, 6 international experts, 22 international Validation Committee members, 11 Jury Committee members, 18 Research Committee members, and 121 registered attendees of the 2-day meeting were involved in the development and validation of the guidelines. In total, 98 recommendations were developed, including 33 on laparoscopic, 34 on robotic, and 31 on general MIPS, covering 22 topics in 8 domains. Out of 98 recommendations, 97 reached at least 80% consensus among the experts and congress attendees, and all recommendations were externally validated by the Validation Committee. CONCLUSIONS The EGUMIPS evidence-based guidelines on laparoscopic and robotic MIPS can be applied in current clinical practice to provide guidance to patients, surgeons, policy-makers, and medical societies.
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Affiliation(s)
- Mohammad Abu Hilal
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Tess M.E. van Ramshorst
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Safi Dokmak
- Department of HPB surgery and liver transplantation, AP-HP, Beaujon Hospital, DMU DIGEST, Clichy, France
| | - Bjørn Edwin
- The Intervention Centre, Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital and Institute of Medicine, Oslo University, Oslo, Norway
| | - Tobias Keck
- Clinic for Surgery, University of Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Igor Khatkov
- Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia
| | - Jawad Ahmad
- Department of Surgery, University Hospitals Coventry and Warwickshire, West Midlands, UK
| | - Hani Al Saati
- Department of Surgery, Salmanyia Medical Complex, Manama, Bahrain
| | - Adnan Alseidi
- Department of Surgery, University of California - San Francisco, San Francisco, California
| | - Juan S. Azagra
- Department of General & Minimally Invasive Surgery (Laparoscopy & Robotic), Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Bergthor Björnsson
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Fatih M. Can
- Department of General Surgery, Bayindir Sogutozu Hospital, Ankara, Turkey
| | - Mathieu D’Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Mikhail Efanov
- Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia
| | - Francisco Espin Alvarez
- Department of Hepato-Pancreato-Biliary Surgery, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Alessandro Esposito
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Giovanni Ferrari
- Division of Minimally invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Andrew A. Gumbs
- Department of Visceral Surgery, Centre Hospitalier Intercommunal de Poissy/Saint-Germain-en-Laye, Poissy, France
| | - Melissa E. Hogg
- Department of Surgery, Northshore University HealthSystem, Chicago, Illinois
| | - Cristiano G.S. Huscher
- Department of Oncologic Surgery, Casa di Cura Cobellis, Vallo Della Lucania, Salerno, Italy
| | - Benedetto Ielpo
- Hepato-Biliary and Pancreatic Surgery Unit, Hospital del Mar, Barcelona, Spain
| | - Arpad Ivanecz
- Department of Abdominal and General Surgery, University Medical Center Maribor, Maribor, Slovenia
| | - Jin-Young Jang
- Departments of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Rong Liu
- Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Misha D.P. Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Krishna Menon
- Institute of Liver Studies, King’s College Hospital, London, UK
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tullio Piardi
- Department of Hepatobiliary, Pancreatic, and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France
| | - Olivier Saint-Marc
- Department of Surgery, Centre Hospitalier Regional Orleans, Orleans, France
| | - Steve White
- Department of HPB and Liver Transplant Surgery, The Freeman Hospital, Newcastle, United Kingdom
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul, Korea
| | - Alessandro Zerbi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy and IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Claudio Bassi
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Frederik Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Carlos Chan
- Surgery Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico
| | - Felipe J. Coimbra
- Department of Abdominal Surgery, AC Camargo Cancer Center, São Paulo, Brazil
| | - Kevin C.P. Conlon
- Department of Surgery, St. Vincent’s University Hospital Dublin, Ireland
| | - Andrew Cook
- Southampton Clinical Trials Unit, University Hospital Southampton, Southampton, UK
| | | | - Massimo Falconi
- Pancreas Translational & Clinical Research Center, San Raffaele IRCCS, Università Vita-Salute, Milan, Italy
| | - Clarissa Ferrari
- Unit of Statistics, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Isabella Frigerio
- Department of HPB Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | | | - Michelle L. De Oliveira
- Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Switzerland
| | - Antonio D. Pinna
- Department of Abdominal and Transplant Surgery, Cleveland Clinic Florida, Weston, Florida
| | - John N. Primrose
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Alain Sauvanet
- Department of HPB Surgery and Liver Transplantation, Hospital of Beaujon, Paris, France
| | - Alejandro Serrablo
- HPB Surgical Division, Miguel Servet University Hospital, Zaragoza, Spain
| | - Sameer Smadi
- Department of Surgery, King Hussein Medical Center, Amman, Jordan
| | - Ali Badran
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Magomet Baychorov
- Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia
| | - Elisa Bannone
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Eduard A. van Bodegraven
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | - Anouk M.L.H. Emmen
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | - Alessandro Giani
- Division of Minimally invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nine de Graaf
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | - Jony van Hilst
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | - Leia R. Jones
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | - Giovanni B. Levi Sandri
- Division of General Surgery and Liver Transplantation, S. Camillo Forlanini Hospital, Rome, Italy
| | - Alessandra Pulvirenti
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Marco Ramera
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Niki Rashidian
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Mushegh A. Sahakyan
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Surgery N1, Yerevan State Medical University, Yerevan, Armenia
| | - Bas A. Uijterwijk
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | - Pietro Zampedri
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Maurice J.W. Zwart
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | - Sergio Alfieri
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefano Berti
- Department of General Surgery, “Sant’Andrea” Hospital La Spezia, La Spezia, Italy
| | - Giovanni Butturini
- Department of HPB Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Fabrizio Di Benedetto
- Hepatopancreatobiliary Surgery and Liver Transplant Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe M. Ettorre
- Division of General Surgery and Liver Transplantation, S. Camillo Forlanini Hospital, Rome, Italy
| | - Felice Giuliante
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elio Jovine
- Alma Mater Studiorum, University of Bologna, AOU Sant’Orsola Malpighi, IRCCS at Maggiore Hospital, Bologna, Italy
| | - Riccardo Memeo
- Department of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, Bari, Italy
| | - Nazario Portolani
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Italy
| | - Andrea Ruzzenente
- Department of Surgery, General and Hepatobiliary Surgery, University Hospital G.B. Rossi, University and Hospital Trust of Verona, Verona, Italy
| | - Roberto Salvia
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Ajith K. Siriwardena
- Hepatobiliary and Pancreatic Surgery Unit, Manchester University NHS FT, Manchester, UK
| | - Marc G. Besselink
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | - Horacio J. Asbun
- Hepato-Biliary and Pancreas Surgery, Miami Cancer Institute, Miami, Florida, USA
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Goh BKP, Han HS, Chen KH, Chua DW, Chan CY, Cipriani F, Aghayan DL, Fretland AA, Sijberden J, D'Silva M, Siow TF, Kato Y, Lim C, Nghia PP, Herman P, Marino MV, Mazzaferro V, Chiow AKH, Sucandy I, Ivanecz A, Choi SH, Lee JH, Gastaca M, Vivarelli M, Giuliante F, Ruzzenente A, Yong CC, Yin M, Chen Z, Fondevila C, Efanov M, Rotellar F, Choi GH, Campos RR, Wang X, Sutcliffe RP, Pratschke J, Lai E, Chong CC, D'Hondt M, Monden K, Lopez-Ben S, Coelho FF, Kingham TP, Liu R, Long TCD, Ferrero A, Sandri GBL, Saleh M, Cherqui D, Scatton O, Soubrane O, Wakabayashi G, Troisi RI, Cheung TT, Sugioka A, Hilal MA, Fuks D, Edwin B, Aldrighetti L. Defining Global Benchmarks for Laparoscopic Liver Resections: An International Multicenter Study. Ann Surg 2023; 277:e839-e848. [PMID: 35837974 DOI: 10.1097/sla.0000000000005530] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To establish global benchmark outcomes indicators after laparoscopic liver resections (L-LR). BACKGROUND There is limited published data to date on the best achievable outcomes after L-LR. METHODS This is a post hoc analysis of a multicenter database of 11,983 patients undergoing L-LR in 45 international centers in 4 continents between 2015 and 2020. Three specific procedures: left lateral sectionectomy (LLS), left hepatectomy (LH), and right hepatectomy (RH) were selected to represent the 3 difficulty levels of L-LR. Fifteen outcome indicators were selected to establish benchmark cutoffs. RESULTS There were 3519 L-LR (LLS, LH, RH) of which 1258 L-LR (40.6%) cases performed in 34 benchmark expert centers qualified as low-risk benchmark cases. These included 659 LLS (52.4%), 306 LH (24.3%), and 293 RH (23.3%). The benchmark outcomes established for operation time, open conversion rate, blood loss ≥500 mL, blood transfusion rate, postoperative morbidity, major morbidity, and 90-day mortality after LLS, LH, and RH were 209.5, 302, and 426 minutes; 2.1%, 13.4%, and 13.0%; 3.2%, 20%, and 47.1%; 0%, 7.1%, and 10.5%; 11.1%, 20%, and 50%; 0%, 7.1%, and 20%; and 0%, 0%, and 0%, respectively. CONCLUSIONS This study established the first global benchmark outcomes for L-LR in a large-scale international patient cohort. It provides an up-to-date reference regarding the "best achievable" results for L-LR for which centers adopting L-LR can use as a comparison to enable an objective assessment of performance gaps and learning curves.
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Affiliation(s)
- Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery,, Singapore General Hospital, National Cancer Centre Singapore and Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Hospital Bundang, Seoul National University College of Medicine, Seoul, Korea
| | - Kuo-Hsin Chen
- Division of General Surgery, Department of Surgery, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Darren W Chua
- Department of Hepatopancreatobiliary and Transplant Surgery,, Singapore General Hospital, National Cancer Centre Singapore and Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Chung-Yip Chan
- Department of Hepatopancreatobiliary and Transplant Surgery,, Singapore General Hospital, National Cancer Centre Singapore and Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Davit L Aghayan
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Asmund A Fretland
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jasper Sijberden
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia,Italy
| | - Mizelle D'Silva
- Department of Surgery, Seoul National University Hospital Bundang, Seoul National University College of Medicine, Seoul, Korea
| | - Tiing Foong Siow
- Division of General Surgery, Department of Surgery, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yutaro Kato
- Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Chetana Lim
- Department of Digestive, HBP and Liver Transplantation, Pitie Salpetriere Hospital, APHP Paris, Sorbonne Universite, Paris, France
| | - Phan Phuoc Nghia
- HPB Surgery Department, University Medical Center, Ho Chi Minh City, Vietnam
| | - Paulo Herman
- Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Marco V Marino
- General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
- Oncologic Surgery Department, P. Giaccone University Hospital, Palermo, Italy
| | - Vincenzo Mazzaferro
- HPB Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano and University of Milan, Milan, Italy
| | - Adrian K H Chiow
- Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore
| | | | - Arpad Ivanecz
- Department of Abdominal and General Surgery, University Medical Center Maribor, Maribor, Slovenia
| | - Sung Hoon Choi
- Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jae Hoon Lee
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mikel Gastaca
- Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - Marco Vivarelli
- HPB Surgery and Transplantation Unit, United Hospital of Ancona, Department of Sperimental and Clinical Medicine Polytechnic University of Marche, Ancona, Italy
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Ruzzenente
- Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, GB Rossi Hospital, Verona, Italy
| | - Chee-Chien Yong
- Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Mengqui Yin
- Department of Hepatobiliary Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Zewei Chen
- Department of Hepatobiliary Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Constantino Fondevila
- General and Digestive Surgery, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
- General and Digestive Surgery, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Mikhail Efanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia
| | - Fernando Rotellar
- HPB and Liver Transplant Unit, Department of General Surgery, University Clinic of Navarra, University of Navarra, Pamplona, Spain
- Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - Gi-Hong Choi
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ricardo R Campos
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
| | - Xiaoying Wang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Robert P Sutcliffe
- Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eric Lai
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - Charing C Chong
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Kazuteru Monden
- Department of Surgery, Fukuyama City Hospital, Hiroshima, Japan
| | - Santiago Lopez-Ben
- Hepatobiliary and Pancreatic Surgery Unit, Department of Surgery, Dr. Josep Trueta Hospital, IdIBGi, Girona, Spain
| | - Fabricio F Coelho
- Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | | | - Rong Liu
- Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Tran Cong Duy Long
- Department of Hepatopancreatobiliary Surgery, University Medical Center, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
| | | | - Mansour Saleh
- Department of Hepatobiliary Surgery, Assistance Publique Hopitaux de Paris, Centre Hepato-Biliaire, Paul-Brousse Hospital, Villejuif, France
| | - Daniel Cherqui
- Department of Hepatobiliary Surgery, Assistance Publique Hopitaux de Paris, Centre Hepato-Biliaire, Paul-Brousse Hospital, Villejuif, France
| | - Olivier Scatton
- Department of Digestive, HBP and Liver Transplantation, Pitie Salpetriere Hospital, APHP Paris, Sorbonne Universite, Paris, France
| | - Olivier Soubrane
- Department of Digestive, Oncologic, and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan
| | - Roberto I Troisi
- Division of HPB, Department of Clinical Medicine and Surgery, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy
| | - Tan-To Cheung
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Atsushi Sugioka
- Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Mohammad Abu Hilal
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia,Italy
- Department of Surgery, University Hospital Southampton, Southampton, UK
| | - David Fuks
- Department of Digestive, Oncologic, and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France
| | - Bjørn Edwin
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
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Levi Sandri GB, Abu Hilal M, Dokmak S, Edwin B, Hackert T, Keck T, Khatkov I, Besselink MG, Boggi U. Figures do matter: A literature review of 4587 robotic pancreatic resections and their implications on training. J Hepatobiliary Pancreat Sci 2023; 30:21-35. [PMID: 35751504 DOI: 10.1002/jhbp.1209] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/07/2022] [Accepted: 06/16/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The use of robotic assistance in minimally invasive pancreatic resection is quickly growing. METHODS We present a systematic review of the literature regarding all types of robotic pancreatic resection (RPR). Our aim is to show for which procedures there is enough experience to permit safe training and provide an estimation of how many centers could serve as teaching institutions. RESULTS Sixty-four studies reporting on 4587 RPRs were analyzed. A total of 2598 pancreatoduodenectomies (PD) were reported by 28 centers from Europe (6/28; 21.4%), the Americas (11/28; 39.3%), and Asia (11/28; 39.3%). Six studies reported >100 robot PD (1694/2598; 65.2%). A total of 1618 distal pancreatectomies (DP) were reported by 29 centers from Europe (10/29; 34.5%), the Americas (10/29; 34.5%), and Asia (9/29; 31%). Five studies reported >100 robotic DP (748/1618; 46.2%). A total of 154 central pancreatectomies were reported by six centers from Europe (1/6; 16.7%), the Americas (2/6; 33.3%), and Asia (3/6; 50%). Only 49 total pancreatectomies were reported. Finally, 168 enucleations were reported in seven studies (with a mean of 15.4 cases per study). A single center reported on 60 enucleations (35.7%). Results of each type of robotic procedure are also presented. CONCLUSIONS Experience with RPR is still quite limited. Despite high case volume not being sufficient to warrant optimal training opportunities, it is certainly a key component of every successful training program and is a major criterion for fellowship accreditation. From this review, it appears that only PD and DP can currently be taught at few institutions worldwide.
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Affiliation(s)
| | - Mohammed Abu Hilal
- Department of Surgery, Fondazione Poliambulanza - Istituto Ospedaliero, Brescia, Italy
| | - Safi Dokmak
- Department of HPB Surgery and Liver Transplantation, DMU DIGEST, AP-HP, Hôpital Beaujon, Clichy, France
| | - Bjørn Edwin
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Thilo Hackert
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Tobias Keck
- Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Igor Khatkov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Ugo Boggi
- Department of Translational Research and New Surgical and Medical Technologies, Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
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Levi Sandri GB, Lai Q, Ravaioli M, Di Sandro S, Balzano E, Pagano D, Magistri P, Di Benedetto F, Rossi M, Gruttadauria S, De Simone P, Ettorre GM, De Carlis L, Cescon M, Colasanti M, Mennini G, Serenari M, Ferla F, Tincani G, Francesco FD, Guidetti C. The Role of Salvage Transplantation in Patients Initially Treated With Open Versus Minimally Invasive Liver Surgery: An Intention-to-Treat Analysis. Liver Transpl 2020; 26:878-887. [PMID: 32246741 DOI: 10.1002/lt.25768] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/02/2020] [Accepted: 03/11/2020] [Indexed: 01/15/2023]
Abstract
Despite gaining wide consensus in the management of hepatocellular carcinoma (HCC), minimally invasive liver surgery (MILS) has been poorly investigated for its role in the setting of salvage liver transplantation (SLT). A multicenter retrospective analysis was carried out in 6 Italian centers on 211 patients with HCC who were initially resected with open (n = 167) versus MILS (n = 44) and eventually wait-listed for SLT. The secondary endpoint was identification of risk factors for posttransplant death and tumor recurrence. The enrolled patients included 211 HCC patients resected with open surgery (n = 167) versus MILS (n = 44) and wait-listed for SLT between January 2007 and December 2017. We analyzed the intention-to-treat survival of these patients. MILS was the most important protective factor for the composite risk of delisting, posttransplant patient death, and HCC recurrence (OR, 0.26; 95% confidence interval [CI], 0.11-0.63; P = 0.003). MILS was also the only independent protective factor for the risk of post-SLT patient death (OR, 0.29; 95% CI, 0.09-0.93; P = 0.04). After propensity score matching, MILS was the only independent protective factor against the risk of delisting, posttransplant death, and HCC recurrence (OR, 0.22; 95% CI, 0.07-0.75; P = 0.02). On the basis of the current analysis, MILS seems protective over open surgery for the risk of delisting, posttransplant patient death, and tumor recurrence. Larger prospective studies balancing liver function and tumor stage are strongly favored to better clarify the beneficial effect of MILS for HCC patients eventually referred to SLT.
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Affiliation(s)
- Giovanni B Levi Sandri
- Division of General Surgery and Liver Transplantation, Polo Ospedaliero Interaziendale Trapianti, San Camillo-Forlanini Hospital, Rome, Italy
| | - Quirino Lai
- Department of General Surgery and Organ Transplantation, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Matteo Ravaioli
- Department of General Surgery and Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Stefano Di Sandro
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Emanuele Balzano
- Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Duilio Pagano
- Department for the Treatment and the Study of Abdominal Diseases and Abdominal Transplantation, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center, Palermo, Italy
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Rossi
- Department of General Surgery and Organ Transplantation, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Salvatore Gruttadauria
- Department for the Treatment and the Study of Abdominal Diseases and Abdominal Transplantation, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center, Palermo, Italy
| | - Paolo De Simone
- Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Giuseppe M Ettorre
- Division of General Surgery and Liver Transplantation, Polo Ospedaliero Interaziendale Trapianti, San Camillo-Forlanini Hospital, Rome, Italy
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Matteo Cescon
- Department of General Surgery and Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marco Colasanti
- Division of General Surgery and Liver Transplantation, Polo Ospedaliero Interaziendale Trapianti, San Camillo-Forlanini Hospital, Rome, Italy
| | - Gianluca Mennini
- Department of General Surgery and Organ Transplantation, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Matteo Serenari
- Department of General Surgery and Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Fabio Ferla
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Giovanni Tincani
- Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Fabrizio Di Francesco
- Department for the Treatment and the Study of Abdominal Diseases and Abdominal Transplantation, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center, Palermo, Italy
| | - Cristiano Guidetti
- Department for the Treatment and the Study of Abdominal Diseases and Abdominal Transplantation, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center, Palermo, Italy
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5
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Rayar M, Levi Sandri GB, Cusumano C, Locher C, Houssel-Debry P, Camus C, Lombard N, Desfourneaux V, Lakehal M, Meunier B, Sulpice L, Boudjema K. Benefits of temporary portocaval shunt during orthotopic liver transplantation with vena cava preservation: A propensity score analysis. Liver Transpl 2017; 23:174-183. [PMID: 27706895 DOI: 10.1002/lt.24650] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/20/2016] [Accepted: 09/26/2016] [Indexed: 02/07/2023]
Abstract
During orthotopic liver transplantation (OLT), clamping of the portal vein induces splanchnic venous congestion and accumulation of noxious compounds. These adverse effects could increase ischemia/reperfusion injury and subsequently the risk of graft dysfunction, especially for grafts harvested from extended criteria donors (ECDs). Temporary portocaval shunt (TPCS) could prevent these complications. Between 2002 and 2013, all OLTs performed in our center were retrospectively analyzed and a propensity score matching analysis was used to compare the effect of TPCS in 686 patients (343 in each group). Patients in the TPCS group required fewer intraoperative transfusions (median number of packed red blood cells-5 versus 6; P = 0.02; median number of fresh frozen plasma-5 versus 6; P = 0.02); had improvement of postoperative biological parameters (prothrombin time, Factor V, international normalized ratio, alkaline phosphatase, and gamma-glutamyltransferase levels); and showed significant reduction of biliary complications (4.7% versus 10.2%; P = 0.006). Survival analysis revealed that TPCS improved 3-month graft survival (94.2% versus 88.6%; P = 0.01) as well as longterm survival of elderly (ie, age > 70 years) donor grafts (P = 0.02). In conclusion, the use of TPCS should be recommended especially when considering an ECD graft. Liver Transplantation 23 174-183 2017 AASLD.
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Affiliation(s)
- Michel Rayar
- Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France.,INSERM, CIC 1414, Rennes, France.,Faculté de Médecine, Université Rennes 1, Rennes, France
| | - Giovanni B Levi Sandri
- Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Caterina Cusumano
- Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Clara Locher
- Service de Pharmacologie Clinique et Épidémiologique, Centre Hospitalier Universitaire Rennes, Rennes, France.,INSERM, CIC 1414, Rennes, France.,Faculté de Médecine, Université Rennes 1, Rennes, France
| | - Pauline Houssel-Debry
- Service des Maladies du Foie, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Christophe Camus
- Réanimation Médicale, Centre Hospitalier Universitaire Rennes, Rennes, France.,INSERM, CIC 1414, Rennes, France
| | - Nicolas Lombard
- Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Veronique Desfourneaux
- Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Mohamed Lakehal
- Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Bernard Meunier
- Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France.,Faculté de Médecine, Université Rennes 1, Rennes, France
| | - Laurent Sulpice
- Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France.,INSERM, CIC 1414, Rennes, France.,Faculté de Médecine, Université Rennes 1, Rennes, France
| | - Karim Boudjema
- Service de Chirurgie Hépatobiliaire et Digestive, Centre Hospitalier Universitaire Rennes, Rennes, France.,INSERM, CIC 1414, Rennes, France.,Faculté de Médecine, Université Rennes 1, Rennes, France
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6
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Levi Sandri GB, de Werra E, Mascianà G, Guerra F, Spoletini G, Lai Q. The use of robotic surgery in abdominal organ transplantation: A literature review. Clin Transplant 2016; 31. [PMID: 27726195 DOI: 10.1111/ctr.12856] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Giovanni B. Levi Sandri
- Division of General Surgery and Liver Transplantation; San Camillo Hospital; Rome Italy
- Department of Surgical Sciences; Sapienza University of Rome; Rome Italy
| | - Edoardo de Werra
- Division of General Surgery and Liver Transplantation; San Camillo Hospital; Rome Italy
| | - Gianluca Mascianà
- Division of General Surgery and Liver Transplantation; San Camillo Hospital; Rome Italy
| | - Francesco Guerra
- Division of Oncological and Robotic General Surgery; Careggi University Hospital; Florence Italy
| | - Gabriele Spoletini
- Department of HPB and Liver Transplant Surgery; Royal Free Hospital; London UK
| | - Quirino Lai
- Transplant Unit; Department of Surgery; University of L'Aquila; San Salvatore Hospital; L'Aquila Italy
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7
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Levi Sandri GB, Colasanti M, Vennarecci G, Ettorre GM. Paraneoplastic arthritis as first symptom of a liver inflammatory pseudotumor-like follicular dendritic cell sarcoma. Liver Int 2016; 36:1392. [PMID: 27125361 DOI: 10.1111/liv.13148] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - Marco Colasanti
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy
| | - Giovanni Vennarecci
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy
| | - Giuseppe M Ettorre
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy
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8
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Levi Sandri GB, Ettorre GM, Vennarecci G. Hepatic angiomyolipoma and neurofibromatosis type 2: a novel association. Liver Int 2014; 34:1445. [PMID: 24314304 DOI: 10.1111/liv.12426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 12/01/2013] [Indexed: 02/13/2023]
Affiliation(s)
- Giovanni B Levi Sandri
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, Roma, Italy
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9
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Melandro F, Lai Q, Levi Sandri GB, Guglielmo N, Di Laudo M, Morabito V, Pretagostini R, Berloco PB, Rossi M. A case of portal vein arterialization after a liver transplant. EXP CLIN TRANSPLANT 2014; 11:287-9. [PMID: 23767946 DOI: 10.6002/ect.2012.0172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hepatic artery thrombosis represents a potentially deadly complication after a liver transplant. Portal vein arterialization recently has been proposed as a bridge approach in patients with hepatic artery thrombosis needing a retransplant. We report the case of a 53-year-old man treated with a liver transplant for a cryptogenetic cirrhosis. One month after a liver transplant, a hepatic artery thrombosis was documented, and a portal vein arterialization as bridge therapy for another liver transplant was performed. After surgery, improvement in the patient's liver functioning was seen. No signs of portal hypertension or hepatic abscesses were documented. Unfortunately, 8 months after the liver transplant, the patient experienced a severe urinary infection caused by a multidrug-resistant Klebsiella and died. An increase in the oxygen supply to the liver parenchyma after portal vein arterializations represents rationale use for managing hepatic artery thromboses. Several cases of treating post liver transplant hepatic artery thromboses have been reported in the literature. Portal vein arterializations can be used as bridge therapy in well-selected situations of post-liver transplant hepatic artery thromboses. Strict surveillance should be used to prevent the onset of complications that can exclude a patient from a transplant. The correct timing for retransplant is not fully known, but we think the shorter the time to retransplant, the better is the patient survival.
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Affiliation(s)
- Fabio Melandro
- Department of General Surgery and Organ Transplantation, Sapienza University, Umberto I Hospital, Rome, Italy.
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10
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Affiliation(s)
- Giovanni B Levi Sandri
- Department of General Surgery and Organ Transplantation, Umberto I Policlinic of Rome, Sapienza University of Rome, Rome, Italy
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