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van Ramshorst TME, Giani A, Mazzola M, Dokmak S, Ftériche FS, Esposito A, de Pastena M, Lof S, Edwin B, Sahakyan M, Boggi U, Kauffman EF, Fabre JM, Souche RF, Zerbi A, Butturini G, Molenaar Q, Al-Sarireh B, Marino MV, Keck T, White SA, Casadei R, Burdio F, Björnsson B, Soonawalla Z, Koerkamp BG, Fusai GK, Pessaux P, Jah A, Pietrabissa A, Hackert T, D'Hondt M, Pando E, Besselink MG, Ferrari G, Hilal MA. Benchmarking of robotic and laparoscopic spleen-preserving distal pancreatectomy by using two different methods. Br J Surg 2022; 110:76-83. [PMID: 36322465 PMCID: PMC10364499 DOI: 10.1093/bjs/znac352] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/01/2022] [Accepted: 09/30/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Benchmarking is an important tool for quality comparison and improvement. However, no benchmark values are available for minimally invasive spleen-preserving distal pancreatectomy, either laparoscopically or robotically assisted. The aim of this study was to establish benchmarks for these techniques using two different methods. METHODS Data from patients undergoing laparoscopically or robotically assisted spleen-preserving distal pancreatectomy were extracted from a multicentre database (2006-2019). Benchmarks for 10 outcomes were calculated using the Achievable Benchmark of Care (ABC) and best-patient-in-best-centre methods. RESULTS Overall, 951 laparoscopically assisted (77.3 per cent) and 279 robotically assisted (22.7 per cent) procedures were included. Using the ABC method, the benchmarks for laparoscopically assisted and robotically assisted spleen-preserving distal pancreatectomy respectively were: 150 and 207 min for duration of operation, 55 and 100 ml for blood loss, 3.5 and 1.7 per cent for conversion, 0 and 1.7 per cent for failure to preserve the spleen, 27.3 and 34.0 per cent for overall morbidity, 5.1 and 3.3 per cent for major morbidity, 3.6 and 7.1 per cent for pancreatic fistula grade B/C, 5 and 6 days for duration of hospital stay, 2.9 and 5.4 per cent for readmissions, and 0 and 0 per cent for 90-day mortality. Best-patient-in-best-centre methodology revealed milder benchmark cut-offs for laparoscopically and robotically assisted procedures, with operating times of 254 and 262.5 min, blood loss of 150 and 195 ml, conversion rates of 5.8 and 8.2 per cent, rates of failure to salvage spleen of 29.9 and 27.3 per cent, overall morbidity rates of 62.7 and 55.7 per cent, major morbidity rates of 20.4 and 14 per cent, POPF B/C rates of 23.8 and 24.2 per cent, duration of hospital stay of 8 and 8 days, readmission rates of 20 and 15.1 per cent, and 90-day mortality rates of 0 and 0 per cent respectively. CONCLUSION Two benchmark methods for minimally invasive distal pancreatectomy produced different values, and should be interpreted and applied differently.
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Affiliation(s)
- Tess M E van Ramshorst
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.,Amsterdamum UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.,Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - Alessandro Giani
- Division of Minimally Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michele Mazzola
- Division of Minimally Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Safi Dokmak
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Fadhel Samir Ftériche
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Alessandro Esposito
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Matteo de Pastena
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Sanne Lof
- Amsterdamum UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.,Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - Bjørn Edwin
- Intervention Centre and Department of Hepatopancreatobiliary Surgery, Oslo University Hospital, also Institute of Medicine, University of Oslo, Oslo, Norway
| | | | - Ugo Boggi
- Department of Surgery, University Hospital of Pisa, Pisa, Italy
| | | | | | | | - Alessandro Zerbi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy, and IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Giovanni Butturini
- Department of Hepatopancreatobiliary Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - 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
| | | | - Marco V Marino
- General and Emergency Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy.,General Surgery Department, Istituto Villa Salus, Siracusa, Italy
| | - Tobias Keck
- Department of Surgery, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Steven A White
- Department of Surgery, Freeman Hospital, Newcastle upon Tyne, Newcastle, UK
| | - Riccardo Casadei
- Department of Surgery, Sant'Orsola Malphigi Hospital, Bologna, Italy
| | - Fernando Burdio
- Department of Surgery, University Hospital del Mar, Barcelona, Spain
| | - Bergthor Björnsson
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | | | - Bas Groot Koerkamp
- Department of Surgery, Erasmus Medical Centre, Rotterdam, theNetherlands
| | - Giuseppe Kito Fusai
- Hepatopancreatobiliary and Liver Transplant Unit, Royal Free London, London, UK
| | - Patrick Pessaux
- Division of Hepato-Biliary and Pancreatic Surgery, Nouvel Hôpital Civil, University Hospital, Institut Hospitalo-Universitaire de Strasbourg, Strasbourg, France
| | - Asif Jah
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Andrea Pietrabissa
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Thilo Hackert
- Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Elizabeth Pando
- Department of Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Marc G Besselink
- Amsterdamum UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.,Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - Giovanni Ferrari
- Division of Minimally Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Mohammad Abu Hilal
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.,Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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