Laparoscopic pancreatoduodenectomy with open or laparoscopic reconstruction during the learning curve: a multicenter propensity score matched study

Hilst, Jony van; Rooij, Thijs de; Boezem, Peter B. van den; Bosscha, K.; Busch, Olivier R.; Duijvendijk, Peter van; Festen, Sebastiaan; Gerhards, Michael F.; Hingh, Ignace H. J. T. de; Karsten, Tom; Kazemier, Geert; Lips, Daniel J.; Luyer, Misha; Nieuwenhuijs, Vincent B.; Patijn, Gijs A.; Stommel, Martijn W J; Zonderhuis, B.; Daams, Freek; Besselink, Marc G.

doi:10.1016/j.hpb.2018.11.003

Cited by 16 publications

(16 citation statements)

References 45 publications

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“…15 However, this study precluded randomised controlled trials 10,11 and several other important cohort studies, limiting validity of their review. [16][17][18][19][20] Hence, this systematic review aims to comprehensively evaluate all current and relevant evidence and perform a network meta-analysis to identify techniques associated with superior peri-operative outcomes in patients undergoing PD using a similar methodology to a recent publication on distal pancreatectomy. 21 In order to include a broader spectrum of surgical approaches, this review will summarise findings of both randomised and non-randomised studies.…”

Section: Introductionmentioning

confidence: 99%

A systematic review and network meta-analysis of different surgical approaches for pancreaticoduodenectomy

Kamarajah

Bundred

Marc

et al. 2020

HPB

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Background: Minimally invasive pancreaticoduodenectomy (MIPD) is a demanding surgical procedure, thus explaining its slow expansion and limited popularity amongst Hepato-Pancreatico-Biliary (HPB) surgeons. However, three main advantages of robotic assisted pancreaticoduodenectomy (PD) including improved dexterity, 3D vision less surgical fatigue, may overcome some of the hurdles and ultimately lead to a wider adoption. This systematic review and network meta-analysis aims to evaluate the current literature on open and MIPD. Methods: A systematic literature search was conducted for studies reporting robotic, laparoscopic and open surgery for PD. Network meta-analysis of intraoperative (operating time, blood loss, transfusion rate), postoperative (overall and major complications, pancreatic fistula, delayed gastric emptying, length of hospital stay) and oncological outcomes (R0 resection, lymphadenectomy) were performed. Results: Sixty-one studies including 62,529 patients were included in the network meta-analysis, of which 3% (n = 2131) were totally robotic (TR) and 10% (n = 6514) were totally laparoscopic (TL). There were no significant differences between surgical techniques for major complications, overall and grade B/C fistula, biliary leak, mortality and R0 resections. Transfusion rates were significantly lower in TR compared to TL and open. Operative time for TR was longer compared with open and TL. Both TL and TR were associated with significantly lower rates of wound infections, pulmonary complications, shorter length of stay and higher lymph nodes examined when compared to open. TR was associated with significantly lower conversion rates than TL. Conclusion: In summary, this network meta-analysis highlights the variability in techniques within MIPD and compares other variations to the conventional open PD. Current evidence appears to demonstrate MIPD, both laparoscopic and robotic techniques are associated with improved rates of surgical site infections, pulmonary complications, and a shorter hospital stay, with no compromise in oncological outcomes for cancer resections.

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Section: Introductionmentioning

confidence: 99%

A systematic review and network meta-analysis of different surgical approaches for pancreaticoduodenectomy

Kamarajah

Bundred

Marc

et al. 2020

HPB

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“…The initial part of the learning curve associates with higher rate of complications [17]. Recent multicenter propensity score matched study found that during initial (median = 27 (10-37) cases per center) learning curve, there is no benefit that was found for LPD with open reconstruction (hybrid), as compared to totally laparoscopic PD [48]. More than that, according to LAELAPS-2 multicenter training program in LPD, 27 laparoscopic PD was not enough to overcome very early learning curve (commencement of training), which additionally shows the importance of the present study [49].…”

Section: Discussionmentioning

confidence: 99%

“…Kantor et al analyzed 1277 patients after MIPD (robotic, laparoscopic, robotic-assisted laparoscopic, and robotic or laparoscopic procedures with open assistance and observed a 15% urgent conversion rate, (23.3% for laparoscopic PD and 12.5% for robotic PD) [27]. van Hilst et al reported higher conversion rate for LPD with open reconstruction, and the unplanned conversion rate was 21% versus 9% with LPD (p < 0.001) [48]. This can be explained by the fact that the planned conversion is original part of preoperative planning.…”

Section: Discussionmentioning

confidence: 99%

Learning curve of three European centers in laparoscopic, hybrid laparoscopic, and robotic pancreatoduodenectomy

et al. 2021

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Introduction There are limited numbers of high-volume centers performing minimally invasive pancreatoduodenectomy (MIPD) routinely. Several approaches to MIPD have been described. Aim of this analysis was to show the learning curve of three different approaches to MIPD. Focus was on determining the number of cases necessary to obtain proficient level in MIPD. Patients and methods Retrospective study wherein outcomes of 300 consecutive patients at three centers-at each center the initial 100 consecutive patients undergoing MIPD for malignant and benign tumors of the head of the pancreas and perimpullary area, performed by three experienced surgeons were collected and analyzed. Results Overall, 300 patients after MIPD were included: the three different cohorts (laparoscopic n = 100, hybrid n = 100, robotic n = 100). CUSUM analysis of operating time in each center demonstrated that the plateau for laparoscopic PD was n = 61, for hybrid PDes was n = 32 and for robotic PD was n = 68. Median operative time for laparoscopic, hybrid, and robotic approaches was 395 min, 404 min, 510 min, respectively. Intraoperative blood loss for laparoscopic PD, hybrid PD, and robotic PD was 250 ml, 250 ml, and 413 ml, respectively. Delayed gastric emptying occurred 12% in laparoscopic cohort, 10% in hybrid, and 53% in robotic cohort. Major complications (Clavien-Dindo III/IV) rate for laparoscopic PD, hybrid PD, and robotic PD was 32%, 37%, and 22% with 5% death in each cohorts, respectively. Conclusion This analysis of the learning curve of three European centers found a shorter learning curve with hybrid PD as compared to laparoscopic and robotic PD. In implementation of a MIPD program, a stepwise approach might be beneficial.

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confidence: 99%

“…We read article with interest on "Laparoscopic pancreatoduodenectomy with open (LPD-OR) or laparoscopic reconstruction (LPD) during the learning curve: a multicenter propensity score matched study" written by Jony van Hilst colleagues. 1 We congratulate them for on devising this propensity score matched cohort study to compare LPD-OR or LPD.…”

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confidence: 99%

Laparoscopic pancreatoduodenectomy with open reconstruction is still a useful checkpoint during the learning curve to reach laparoscopic reconstruction

Vaishnav

2020

HPB

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We read article with interest on "Laparoscopic pancreatoduodenectomy with open (LPD-OR) or laparoscopic reconstruction (LPD) during the learning curve: a multicenter propensity score matched study" written by Jony van Hilst colleagues. 1 We congratulate them for on devising this propensity score matched cohort study to compare LPD-OR or LPD.Although much literature has been published about postoperative complications of this morbid procedure, we are yet to find clear answer of how to reduce pancreas related complications. We were happy to see that primary aim of this study was to compare post-operative pancreatic fistula rates (POPF) and complications after pancreatoduodenectomy, whereas in two RCTS, 2,3 hospital stay was the primary outcome measure.Minimally invasive approach has proved to be beneficial to patients in all other gastrointestinal surgical procedures. There is no argument against MIS for pancreatic surgery, but due to the complexity of the procedure and post-operative consequences of PD, the learning curve for laparoscopic reconstruction after PD will remain difficult and long even after implementing comprehensive protocols. 4 If we view this study from another angle, it suggests that LPD OR had comparable postoperative outcome with LPD. LPD OR has no added complications during learning curve. So LPD OR can still be a useful checkpoint until a surgeon gains enough experience and confidence for complete laparoscopic resection and reconstruction.

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Laparoscopic pancreatoduodenectomy with open or laparoscopic reconstruction during the learning curve: a multicenter propensity score matched study

Cited by 16 publications

References 45 publications

A systematic review and network meta-analysis of different surgical approaches for pancreaticoduodenectomy

A systematic review and network meta-analysis of different surgical approaches for pancreaticoduodenectomy

Learning curve of three European centers in laparoscopic, hybrid laparoscopic, and robotic pancreatoduodenectomy

Laparoscopic pancreatoduodenectomy with open reconstruction is still a useful checkpoint during the learning curve to reach laparoscopic reconstruction

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