Minimally invasive versus open distal pancreatectomy (LEOPARD): study protocol for a randomized controlled trial

Rooij, Thijs de; Hilst, Jony van; Vogel, Jantien A.; Santvoort, Hjalmar C. van; Boer, Marieke T. de; Boerma, Djamila; Boezem, Peter B. van den; Bonsing, Bert A.; Bosscha, K.; Coene, Peter-Paul; Daams, Freek; Dam, Ronald M. van; Dijkgraaf, Marcel G. W.; Eijck, Casper H. van; Festen, Sebastiaan; Gerhards, Michael F.; Koerkamp, Bas Groot; Hagendoorn, Jeroen; Harst, Erwin van der; Hingh, Ignace H. J. T. de; Dejong, C. H. C.; Kazemier, Geert; Klaase, Joost M.; Kleine, Ruben H J de; Laarhoven, Cornelis J. van; Lips, Daan J.; Luyer, Misha; Molenaar, I.; Nieuwenhuijs, Vincent B.; Patijn, Gijs A.; Roos, Daphne; Scheepers, Joris J.; Schelling, George P. van der; Steenvoorde, Pascal; Swijnenburg, Rutger-Jan; Wijsman, Jan H.; Hilal, Mohammed Abu; Busch, Olivier R.; Besselink, Marc G.

doi:10.1186/s13063-017-1892-9

Cited by 43 publications

(41 citation statements)

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“…These guidelines can be extended after increased experience. In the ongoing Dutch trials on minimally invasive pancreatic surgery patients with a BMI over 35 are excluded (6,7). Tumor characteristics should be considered as well, especially in the beginning of one's learning curve.…”

Section: Patient Selectionmentioning

confidence: 99%

“…These studies suggest several benefits of minimally invasive surgery including less blood loss and shorter hospital stay (2)(3)(4)(5). Currently, multicenter randomized controlled trials are being carried out in the Netherlands comparing open resection with a minimally invasive approach, for both distal pancreatectomy and pancreatoduodenectomy (6,7).…”

Section: Introductionmentioning

confidence: 99%

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Developing a robotic pancreas program: the Dutch experience

et al. 2017

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Robot-assisted surgery has been developed to overcome limitations of conventional laparoscopy aiming to further optimize minimally invasive surgery. Despite the fact that robotics already have been widely adopted in urology, gynecology, and several gastro-intestinal procedures, like colorectal surgery, pancreatic surgery lags behind. Due to the complex nature of the procedure, surgeons probably have been hesitant to apply minimally invasive techniques in pancreatic surgery. Nevertheless, the past few years pancreatic surgery has been catching up. An increasing number of procedures are being performed laparoscopically and robotically, despite it being a highly complex procedure with high morbidity and mortality rates. Since the complex nature and extensiveness of the procedure, the start of a robotic pancreatic program should be properly prepared and should comply with several conditions within high-volume centers. Robotic training plays a significant role in the preparation. In this review we discuss the different aspects of preparation when working towards the start of a robotic pancreas program against the background of our nationwide experience in the Netherlands. a 3D, magnified view of the operative field with intraabdominal articulating instruments, thereby increasing surgical dexterity (8). Potentially, the use of the robotic system enables a larger proportion of pancreatic surgeries to be performed minimally invasively, since the technical benefits of the robot may especially be advantageous in reconstructing anastomoses during a Whipple procedure. Moreover, ergonomics are improved and the use of robotics in minimally invasive surgery potentially shortens the learning curve compared to conventional laparoscopy, as previously shown in different procedures (9,10).Still, pancreatic surgery remains highly complex and is associated with significant morbidity and mortality rates (11-13). Therefore, when starting a robotic program for pancreatic surgery, it should be well prepared and several conditions must be met prior to performing the first procedures. Training of a dedicated multidisciplinary team should play a key-role in the setup. However, specific training programs for teams performing robotic pancreatic surgery are still scarce.In the Netherlands, surgeons have been performing laparoscopic pancreatic surgery sporadically for over ten years (1). In 2012, the first robot-assisted distal pancreatectomies were performed and last year the first robot-assisted pancreatoduodenectomies were performed in the University Medical Center Utrecht (UMC Utrecht) after following the University of Pittsburgh Medical Center (UPMC) training program. Next, this program made available nationwide by the Dutch Pancreatic Cancer Group, similar as was done previously for laparoscopic pancreatic surgery (1). Other centers, including the Erasmus Medical Center Rotterdam, recently followed the program. In this review we discuss the steps we took on our road to our first successful robot-assisted pancreatoduodenectomy. T...

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Section: Patient Selectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Developing a robotic pancreas program: the Dutch experience

et al. 2017

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“…20 Nevertheless, these studies remain retrospective in nature and the Dutch LEOPARD-1 21 and Swedish LAPOP (http://www.isrctn.com/ISRCTN26912858 estimated completion date in 2020) randomized controlled trials should provide a better platform for comparison between both modes of treatment. While minimally invasive pancreatic surgery is still not widely adopted, there are suggestions that similar advantages from laparoscopy seen in the other fields of general surgery can be conferred to pancreatic operations, possibly improving its morbidity rates.…”

Section: Discussionmentioning

confidence: 99%

“…This is already evident in existing meta-analyses comparing laparoscopic (laparoscopic distal pancreatectomy) and open distal pancreatectomy in which reduced intra-operative blood loss and shorter hospital stay along with comparable oncological outcomes were observed in the former procedure. 20 Nevertheless, these studies remain retrospective in nature and the Dutch LEOPARD-1 21 and Swedish LAPOP (http://www.isrctn.com/ISRCTN26912858 estimated completion date in 2020) randomized controlled trials should provide a better platform for comparison between both modes of treatment. The role of MIPD in pancreatic head and periampullary neoplasms generates greater controversy compared to laparoscopic distal pancreatectomy due to its inherent technical difficulty.…”

Section: Discussionmentioning

confidence: 99%

Propensity score‐matched analysis of early outcomes after laparoscopic‐assisted versus open pancreaticoduodenectomy

Tan

Yeo

et al. 2019

ANZ Journal of Surgery

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Background: Minimally invasive pancreaticoduodenectomy (PD) is a feasible option for periampullary tumours. However, it remains a complex procedure with no proven advantages over open PD (OPD). The aim of the study was to compare the outcomes between laparoscopic-assisted PD (LAPD) and OPD using a propensity score-matched analysis. Methods: Retrospective review of 40 patients who underwent PD for periampullary tumours between January 2014 and December 2016 was conducted. The patients were matched 1:1 for age, gender, body mass index, Charlson comorbidty index, tumour size and haematological indices. Peri-operative outcomes were evaluated. Results: LAPD appeared to have a longer median operative time as compared to OPD (LAPD, 425 min (285-597) versus OPD, 369 min (260-500)) (P = 0.066). Intra-operative blood loss was comparable between both groups. Respiratory complications were five times higher in the OPD group (LAPD, 5% versus OPD, 25%) (P = 0.077), while LAPD patients required less time to start ambulating post-operatively (LAPD, 2 days versus OPD, 2 days) (P = 0.021). Pancreas-specific complications and morbidity/mortality rates were similar. Conclusion: LAPD is a safe alternative to OPD in a select group of patients for an institution starting out with minimally invasive PD, and can be used to bridge the learning curve required for total laparoscopic PD. © 2019 Royal Australasian College of Surgeons ANZ J Surg 89 (2019) E190-E194 ANZJSurg.com 12.0 (2.0-39.0) 13.5 (4.0-27.0) 0.480 R0 resection, n (%) 16 (80.0) 19 (95.0) 0.151 LAPD, laparoscopic-assisted pancreaticoduodenectomy; OPD, open pancreaticoduodenectomy.

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“…Patients will increasingly demand the secondary benefits of minimally‐invasive approaches (e.g. decreased pain and improved quality of life), which have been demonstrated with other minimally‐invasive procedures, and are currently being studied in MISP …”

Section: Frontiers In Patient Selectionmentioning

confidence: 99%

Contemporary issues in the surgical management of pancreatic neuroendocrine tumours

Sham

Gage

2019

Surgical Practice

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Pancreatic neuroendocrine tumours (PNET) are relatively rare entities, accounting for 1-2 per cent of pancreatic neoplasms. However, rates of diagnosis have recently increased, in part due to incidental discovery on the widespread use of cross-sectional imaging. While general consensus exists regarding the treatment of large and/or functional PNET, the management of smaller (<2 cm) asymptomatic lesions is less clear. Recent updates in staging guidelines have improved classification of high-and low-risk tumours, and additional genetic analysis (e.g. Death domain-associated protein 6 Gene, Alpha Thalassemia/Mental Retardation Syndrome X-Linked Gene) offers the possibility of enhanced risk stratification to further guide surgical management. In patients who do ultimately require pancreatectomy, the role of minimally-invasive surgery (laparoscopic or robotic) continues to expand.

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Minimally invasive versus open distal pancreatectomy (LEOPARD): study protocol for a randomized controlled trial

Cited by 43 publications

References 43 publications

Developing a robotic pancreas program: the Dutch experience

Developing a robotic pancreas program: the Dutch experience

Propensity score‐matched analysis of early outcomes after laparoscopic‐assisted versus open pancreaticoduodenectomy

Contemporary issues in the surgical management of pancreatic neuroendocrine tumours

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