TY - JOUR
T1 - Nationwide use and Outcome of Minimally Invasive Distal Pancreatectomy in IDEAL Stage IV following a Training Program and Randomized Trial
AU - Korrel, Maarten
AU - van Hilst, Jony
AU - Bosscha, Koop
AU - Busch, Olivier R. C.
AU - Daams, Freek
AU - van Dam, Ronald
AU - van Eijck, Casper H. J.
AU - Festen, Sebastiaan
AU - Groot Koerkamp, Bas
AU - van der Harst, Erwin
AU - Lips, Daan J.
AU - Luyer, Misha D.
AU - de Meijer, Vincent E.
AU - Mieog, J. Sven D.
AU - Molenaar, I. Quintus
AU - Patijn, Gijs A.
AU - van Santvoort, Hjalmar C.
AU - van der Schelling, George P.
AU - Dutch Pancreatic Cancer Group
AU - Stommel, Martijn W. J.
AU - Besselink, Marc G.
N1 - Publisher Copyright: © 2024 Lippincott Williams and Wilkins. All rights reserved.
PY - 2024/2/1
Y1 - 2024/2/1
N2 - Objective: To assess the nationwide long-term uptake and outcomes of minimally invasive distal pancreatectomy (MIDP) after a nationwide training program and randomized trial. Background: Two randomized trials demonstrated the superiority of MIDP over open distal pancreatectomy (ODP) in terms of functional recovery and hospital stay. Data on implementation of MIDP on a nationwide level are lacking. Methods: Nationwide audit-based study including consecutive patients after MIDP and ODP in 16 centers in the Dutch Pancreatic Cancer Audit (2014 to 2021). The cohort was divided into three periods: early implementation, during the LEOPARD randomized trial, and late implementation. Primary endpoints were MIDP implementation rate and textbook outcome. Results: Overall, 1496 patients were included with 848 MIDP (56.5%) and 648 ODP (43.5%). From the early to the late implementation period, the use of MIDP increased from 48.6% to 63.0% and of robotic MIDP from 5.5% to 29.7% (P<0.001). The overall use of MIDP (45% to 75%) and robotic MIDP (1% to 84%) varied widely between centers (P<0.001). In the late implementation period, 5/16 centers performed >75% of procedures as MIDP. After MIDP, in-hospital mortality and textbook outcome remained stable over time. In the late implementation period, ODP was more often performed in ASA score III-IV (24.9% vs. 35.7%, P=0.001), pancreatic cancer (24.2% vs. 45.9%, P<0.001), vascular involvement (4.6% vs. 21.9%, P<0.001), and multivisceral involvement (10.5% vs. 25.3%, P<0.001). After MIDP, shorter hospital stay (median 7 vs. 8 d, P<0.001) and less blood loss (median 150 vs. 500 mL, P<0.001), but more grade B/C postoperative pancreatic fistula (24.4% vs. 17.2%, P=0.008) occurred as compared to ODP. Conclusion: A sustained nationwide implementation of MIDP after a successful training program and randomized trial was obtained with satisfactory outcomes. Future studies should assess the considerable variation in the use of MIDP between centers and, especially, robotic MIDP.
AB - Objective: To assess the nationwide long-term uptake and outcomes of minimally invasive distal pancreatectomy (MIDP) after a nationwide training program and randomized trial. Background: Two randomized trials demonstrated the superiority of MIDP over open distal pancreatectomy (ODP) in terms of functional recovery and hospital stay. Data on implementation of MIDP on a nationwide level are lacking. Methods: Nationwide audit-based study including consecutive patients after MIDP and ODP in 16 centers in the Dutch Pancreatic Cancer Audit (2014 to 2021). The cohort was divided into three periods: early implementation, during the LEOPARD randomized trial, and late implementation. Primary endpoints were MIDP implementation rate and textbook outcome. Results: Overall, 1496 patients were included with 848 MIDP (56.5%) and 648 ODP (43.5%). From the early to the late implementation period, the use of MIDP increased from 48.6% to 63.0% and of robotic MIDP from 5.5% to 29.7% (P<0.001). The overall use of MIDP (45% to 75%) and robotic MIDP (1% to 84%) varied widely between centers (P<0.001). In the late implementation period, 5/16 centers performed >75% of procedures as MIDP. After MIDP, in-hospital mortality and textbook outcome remained stable over time. In the late implementation period, ODP was more often performed in ASA score III-IV (24.9% vs. 35.7%, P=0.001), pancreatic cancer (24.2% vs. 45.9%, P<0.001), vascular involvement (4.6% vs. 21.9%, P<0.001), and multivisceral involvement (10.5% vs. 25.3%, P<0.001). After MIDP, shorter hospital stay (median 7 vs. 8 d, P<0.001) and less blood loss (median 150 vs. 500 mL, P<0.001), but more grade B/C postoperative pancreatic fistula (24.4% vs. 17.2%, P=0.008) occurred as compared to ODP. Conclusion: A sustained nationwide implementation of MIDP after a successful training program and randomized trial was obtained with satisfactory outcomes. Future studies should assess the considerable variation in the use of MIDP between centers and, especially, robotic MIDP.
KW - IDEAL
KW - distal pancreatectomy
KW - laparoscopic
KW - minimally invasive pancreatic surgery
UR - http://www.scopus.com/inward/record.url?scp=85182091292&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000005900
DO - 10.1097/SLA.0000000000005900
M3 - Article
C2 - 37139822
SN - 0003-4932
VL - 279
SP - 323
EP - 330
JO - Annals of surgery
JF - Annals of surgery
IS - 2
ER -