Open Pancreaticoduodenectomy Case Volume Predicts Outcome of Laparoscopic Approach

Kutlu, Onur; Lee, Jeffrey E.; Katz, Matthew H.G.; Tzeng, Ching Wei D.; Wolff, Robert A.; Varadhachary, Gauri R.; Vauthey, Jean Nicolas; Fleming, Jason B.; Conrad, Claudius

doi:10.1097/sla.0000000000002111

Cited by 74 publications

(51 citation statements)

References 33 publications

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“…However, most reported data focusing on the cost comparison between MIPR and OPR are from single‐center, high‐volume institutions. However, 91% of the hospitals in the United States perform only 1–13 PD cases per year as reported previously by our group. Tran et al.…”

Section: Discussionsupporting

confidence: 82%

“…Whereas median charges were similar between LPD and OPD for the total cohort, a subgroup analysis of patients who underwent LPD revealed a significantly shorter hospital stay resulting in significantly lower median charges in the high‐volume hospitals compared to low‐volume hospitals. Since only hospitals performing more than 25 PD cases per year showed a significantly shorter hospital stay , current cost analyses may not be applicable to low‐volume centers.…”

Section: Discussionmentioning

confidence: 99%

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Cost‐effectiveness of minimally invasive pancreatic resection

Joechle

Conrad

2018

J Hepato Biliary Pancreat

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While clinical outcomes of minimally invasive pancreatic resection (MIPR) compared to open surgery are well examined, only few studies focus on its associated cost. The aim of this study is to evaluate cost analyses comparing MIPR to open pancreatic resection (OPR). A systematic review of the literature using PubMed of all published studies between 2000 and 2017 was performed. Studies reporting on cost of laparoscopic distal pancreatectomy (LDP) and laparoscopic pancreatoduodenectomy (LPD) compared to open surgery were identified. Fourteen studies were included, eight that reported a cost comparison between LDP and open surgery and six that compared costs between LPD and open surgery. For both, LDP and LPD, operative costs were higher due to higher costs for surgical equipment. Reports suggest that lower postoperative costs for LDP and LPD could balance out the operative costs resulting in overall decreased costs for the laparoscopic compared to the open approach. Recent results show a positive trend towards cost savings for MIPR. To assess the overall benefit of MIPR compared to OPR comprehensive cost analyses and long-term quality outcomes need to be investigated.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Cost‐effectiveness of minimally invasive pancreatic resection

Joechle

Conrad

2018

J Hepato Biliary Pancreat

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“…Several authors have raised concerns about the potential increase in morbidity and even mortality, especially during the early learning phase. In the study by Kutlu et al , the advantages of LPD, such as shorter hospital stay and lower readmission rate, become apparent only in high‐volume institutions performing more than 25 cases per year . Not unexpectedly lower PD case volumes correlated with poorer outcomes regardless of the surgical approach.…”

Section: Discussionmentioning

confidence: 99%

“…Not unexpectedly lower PD case volumes correlated with poorer outcomes regardless of the surgical approach. However, of even greater concern was that the detrimental effect of lower case volume was exacerbated by the laparoscopic approach . These concerns are especially relevant for institutions in Southeast Asia and the Australasian region whereby truly high‐volume centres such as those in the United States or Korea may not exist .…”

Section: Discussionmentioning

confidence: 99%

Initial experience with laparoscopic and robotic surgery for the treatment of periampullary tumours: single institution experience with the first 30 consecutive cases

Goh

Low

Kam

et al. 2019

ANZ Journal of Surgery

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Background: Concerns have been raised about the safety of minimally invasive surgery (MIS) for pancreatoduodenectomy (PD) during the early learning phase. In this study, we present our initial experience with MIS for periampullary tumours. Methods: Retrospective review of the first 30 consecutive patients who underwent laparoscopic (LS)/robotic surgery (RS) for periampullary tumours between 2014 and 2017. Results: Twenty-seven patients underwent PD, including three total pancreatectomies (TPs) and three underwent palliative bypasses. Twenty underwent LS, of which 18 were hybrid PDs, including two TPs and two bypasses. Ten patients underwent RS, of which nine were PDs, including one TP and one bypass. Five of 10 RSs were totally MIS procedures. There were four PDs with venous resection, of which three were by RS. There were four (13.3%) open conversions all in the LS cohort. There were five (16.7%) major (>grade 2) morbidities, including three pancreatic fistulas (two grade B and one grade C). There was no 30-day and one (3.3%) 90-day mortality. Comparison between RS and LS demonstrated that RS had a higher likelihood of being completed via totally MIS (five (50%) versus 0, P = 0.002), tended to have a shorter post-operative stay (eight (range 6-36) versus 14.5 (range 6-62) days, P = 0.058) but tended to be associated with a longer operation time (670 (range 500-930) versus 577 (range 235-715) min, P = 0.056). Conclusion: Our initial experience demonstrated that both LS and RS can be safely adopted for the treatment of periampullary tumours. The learning curve for RS seemed to be shorter than LS as we could transition more quickly from hybrid PDs to totally MIS safely. © 2019 Royal Australasian College of Surgeons ANZ J Surg 89 (2019) E137-E141 ANZJSurg.com E138 Goh et al.

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“…We observed a significant independent association between hospital volume and quality, such that high-volume hospitals were more likely to perform surgery and to achieve both complete and R0 resections, There is emerging evidence that a strong persistent volumeoutcome relationship exists for complex surgical procedures, whereby high-volume hospitals and surgeons yield better outcomes. [17][18][19][20] Specifically, in renal cancer surgery, which is pertinent to RPS surgery because both involve the retroperitoneum, higher volume status has been associated with undertaking more complex cases, decreased morbidity, and improved survival. 17 To our knowledge, only one other study has investigated the volume-outcome relationship in RPS;…”

Section: Discussionmentioning

confidence: 99%