TY - JOUR

T1 - Robotic Distal Pancreatectomy

T2 - A Novel Standard of Care? Benchmark Values for Surgical Outcomes from 16 International Expert Centers

AU - Müller, Philip C.

AU - Breuer, Eva

AU - Nickel, Felix

AU - Zani, Sabino

AU - Kauffmann, Emanuele

AU - De Franco, Lorenzo

AU - Tschuor, Christoph

AU - Krohn, Paul Suno

AU - Burgdorf, Stefan K.

AU - Jonas, Jan Philipp

AU - Oberkofler, Christian E.

AU - Petrowsky, Henrik

AU - Saint-Marc, Olivier

AU - Seelen, Leonard

AU - Molenaar, Izaak Quintus

AU - Wellner, Ulrich

AU - Keck, Tobias

AU - Coratti, Andrea

AU - Van Dam, Jacob L.

AU - De Wilde, Roeland

AU - Koerkamp, Bas Groot

AU - Valle, Valentina

AU - Giulianotti, Pier

AU - Ghabi, Elie

AU - Moskal, David

AU - Lavu, Harish

AU - Vrochides, Dionisios

AU - Martinie, John

AU - Yeo, Charles

AU - Sánchez-velázquez, Patricia

AU - Ielpo, Benedetto

AU - Ajay, Pranay S.

AU - Shah, Mihir M.

AU - Kooby, David A.

AU - Gao, Song

AU - Hao, Jihui

AU - He, Jin

AU - Boggi, Ugo

AU - Hackert, Thilo

AU - Allen, Peter

AU - Borel-rinkes, Inne H.m.

AU - Clavien, Pierre Alain

PY - 2023

Y1 - 2023

N2 - Background and Objective: Robotic distal pancreatectomy (DP) is an emerging attractive approach, but its role compared to laparoscopic or open surgery remains unclear. Benchmark values are novel and objective tools for such comparisons. The aim of this study was to identify benchmark cutoffs for many outcome parameters for DP with or without splenectomy beyond the learning curve.Methods: This study analyzed outcomes from international expert centers from patients undergoing robotic DP for malignant or benign lesions. After excluding the first 10 cases in each center to reduce the effect of the learning curve, consecutive patients were included from the start of robotic DP up to June 2020. Benchmark patients had no significant comorbidities. Benchmark cutoff values were derived from the 75th or the 25th percentile of the median values of all benchmark centers. Benchmark values were compared to a laparoscopic control group from four high-volume centers and published open DP landmark series.Results: Sixteen centers contributed 755 cases, whereof 345 benchmark patients (46%) were included the analysis. Benchmark cut-offs included: operation time ≤300min, conversion rate ≤3%, clinically relevant POPF ≤32%, 3 months major complication rate ≤26.7% and lymph node retrieval ≥9. The CCI® at 3 months was ≤8.7 without deterioration thereafter. Compared to robotic DP, laparoscopy had significantly higher conversion rates (5x) and overall complications, while open DP was associated with more blood loss and longer hospital stay.Conclusion: This first benchmark study demonstrates that robotic DP provides superior postoperative outcomes compared to laparoscopic and open DP. Robotic DP may be expected to become the approach of choice in minimally invasive DP.

AB - Background and Objective: Robotic distal pancreatectomy (DP) is an emerging attractive approach, but its role compared to laparoscopic or open surgery remains unclear. Benchmark values are novel and objective tools for such comparisons. The aim of this study was to identify benchmark cutoffs for many outcome parameters for DP with or without splenectomy beyond the learning curve.Methods: This study analyzed outcomes from international expert centers from patients undergoing robotic DP for malignant or benign lesions. After excluding the first 10 cases in each center to reduce the effect of the learning curve, consecutive patients were included from the start of robotic DP up to June 2020. Benchmark patients had no significant comorbidities. Benchmark cutoff values were derived from the 75th or the 25th percentile of the median values of all benchmark centers. Benchmark values were compared to a laparoscopic control group from four high-volume centers and published open DP landmark series.Results: Sixteen centers contributed 755 cases, whereof 345 benchmark patients (46%) were included the analysis. Benchmark cut-offs included: operation time ≤300min, conversion rate ≤3%, clinically relevant POPF ≤32%, 3 months major complication rate ≤26.7% and lymph node retrieval ≥9. The CCI® at 3 months was ≤8.7 without deterioration thereafter. Compared to robotic DP, laparoscopy had significantly higher conversion rates (5x) and overall complications, while open DP was associated with more blood loss and longer hospital stay.Conclusion: This first benchmark study demonstrates that robotic DP provides superior postoperative outcomes compared to laparoscopic and open DP. Robotic DP may be expected to become the approach of choice in minimally invasive DP.

U2 - 10.1097/SLA.0000000000005601

DO - 10.1097/SLA.0000000000005601

M3 - Journal article

C2 - 35861061

VL - 278

SP - 253

EP - 259

JO - Advances in Surgery

JF - Advances in Surgery

SN - 0003-4932

IS - 2

ER -