Standardizing terminology for minimally invasive pancreatic resection

Montagnini, André L.; Røsok, Bård I.; Asbun, Horacio J.; Barkun, Jeffrey; Besselink, Marc G.; Boggi, Ugo; Conlon, Kevin C.; Fingerhut, Abe; Han, Ho Seong; Hansen, Paul; Hogg, Melissa E.; Kendrick, Michael L.; Palanivelu, Chinnusamy; Shrikhande, Shailesh V.; Wakabayashi, Go; Zeh, Herbert J.; Vollmer, Charles M.; Kooby, David A.

doi:10.1016/j.hpb.2017.01.006

Cited by 44 publications

(30 citation statements)

References 46 publications

(40 reference statements)

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“…Patients allocated to MIPD who undergo intraoperative conversion to open pancreatoduodenectomy will still be analyzed in the MIPD group according to intention-to-treat principles. Reasons for conversion are registered and categorized in urgent and non-urgent conversions [ 18 ].…”

Section: Methodsmentioning

confidence: 99%

Minimally invasive versus open pancreatoduodenectomy (LEOPARD-2): study protocol for a randomized controlled trial

Rooij

Hilst

Bosscha

et al. 2018

Trials

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152

157

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BackgroundData from observational studies suggest that minimally invasive pancreatoduodenectomy (MIPD) is superior to open pancreatoduodenectomy regarding intraoperative blood loss, postoperative morbidity, and length of hospital stay, without increasing total costs. However, several case-matched studies failed to demonstrate superiority of MIPD, and large registry studies from the USA even suggested increased mortality for MIPDs performed in low-volume (<10 MIPDs annually) centers. Randomized controlled multicenter trials are lacking but clearly required. We hypothesize that time to functional recovery is shorter after MIPD compared with open pancreatoduodenectomy, even in an enhanced recovery setting.Methods/designLEOPARD-2 is a randomized controlled, parallel-group, patient-blinded, multicenter, phase 2/3, superiority trial in centers that completed the Dutch Pancreatic Cancer Group LAELAPS-2 training program for laparoscopic pancreatoduodenectomy or LAELAPS-3 training program for robot-assisted pancreatoduodenectomy and have performed ≥ 20 MIPDs. A total of 136 patients with symptomatic benign, premalignant, or malignant disease will be randomly assigned to undergo minimally invasive or open pancreatoduodenectomy in an enhanced recovery setting. After the first 40 patients (phase 2), the data safety monitoring board will assess safety outcomes (not blinded for treatment allocation) and decide on continuation to phase 3. Patients from phase 2 will then be included in phase 3. The primary outcome measure is time (days) to functional recovery. All patients will be blinded for the surgical approach, at least until postoperative day 5, but preferably until functional recovery has been attained. Secondary outcome measures are operative and postoperative outcomes, including clinically relevant complications, mortality, quality of life, and costs.DiscussionThe LEOPARD-2 trial is designed to assess whether MIPD reduces time to functional recovery, as compared with open pancreatoduodenectomy in an enhanced recovery setting.Trial registrationNetherlands Trial Register, NTR5689. Registered on 2 March 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2423-4) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Minimally invasive versus open pancreatoduodenectomy (LEOPARD-2): study protocol for a randomized controlled trial

Rooij

Hilst

Bosscha

et al. 2018

Trials

Self Cite

152

157

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“…Distal pancreatectomy was defined as resection of the part of the pancreas located to the left side of the superior mesenteric vein. The definition of conversion was met if a resection was attempted via the laparoscopic approach, but required a laparotomy or hand assistance for any reason other than trocar placement or specimen extraction.…”

Section: Methodsmentioning

confidence: 99%

Multicentre observational cohort study of implementation and outcomes of laparoscopic distal pancreatectomy

Lof

Moekotte

Al-Sarireh

et al. 2019

British Journal of Surgery

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Background: Laparoscopic distal pancreatectomy (LDP) is increasingly being performed as an alternative to open surgery. Whether the implementation and corresponding learning curve of LDP have an impact on patient outcome is unknown. The aim was to investigate the temporal trends in practice across UK centres. Methods: This was a retrospective multicentre observational cohort study of LDP in 11 tertiary referral centres in the UK between 2006 and 2016. The learning curve was analysed by pooling data for the first 15 consecutive patients who had LDP and examining trends in surgical outcomes in subsequent patients. Results: In total, 570 patients underwent LDP, whereas 888 underwent open resection. For LDP the median duration of operation was 240 min, with 200 ml blood loss. The conversion rate was 12⋅1 per cent. Neuroendocrine tumours (26⋅7 per cent) and mucinous cystic neoplasms (19⋅7 per cent) were commonest indications. The proportion of LDPs increased from 24⋅4 per cent in 2006-2009 (P1) to 46⋅0 per cent in 2014-2016 (P3) (P < 0⋅001). LDP was increasingly performed for patients aged 70 years or more (16 per cent in P1 versus 34⋅4 per cent in P3; P = 0⋅002), pancreatic ductal adenocarcinoma (6 versus 19⋅1 per cent; P = 0⋅005) and advanced malignant tumours (27 versus 52 per cent; P = 0⋅016). With increasing experience, there was a trend for a decrease in blood transfusion rate (14⋅1 per cent for procedures 1-15 to 3⋅5 per cent for procedures 46-75; P = 0⋅008), ICU admissions (32⋅7 to 19⋅2 per cent; P = 0⋅021) and median duration of hospital stay (7 (i.q.r. 5-9) to 6 (4-7) days; P = 0⋅002). After 30 procedures, a decrease was noted in rates of both overall morbidity (57⋅7 versus 42⋅2 per cent for procedures 16-30 versus 46-75 respectively; P = 0⋅009) and severe morbidity (18⋅8 versus 9⋅7 per cent; P = 0⋅031).Conclusion: LDP has increased as a treatment option for lesions of the distal pancreas as indications for the procedure have expanded. Perioperative outcomes improved with the number of procedures performed. * Other members of the Minimally Invasive Liver and Pancreatic Surgery Study Group -UK are co-authors of this study and can be found under the heading Collaborators

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“…However, as advised by the IHPBA State-of-the-Art conference on Minimally Invasive Pancreatic Resection (Sao Paulo, 2016), this terminology should be avoided. 29,30 In LPD-OR, the timing of planned conversion for LPD-OR was registered and unplanned conversion was defined as any laparotomy, incision enlargement or hand-assistance other than for planned open anastomoses. In LPD, all conversions were defined as unplanned.…”

Section: Definitionsmentioning

confidence: 99%

“…All unplanned conversions during LPD-OR and LPD were divided into urgent and non-urgent conversions according to the IHPBA State-of-the-Art conference advice. 30 Postoperative major complications were defined as a Clavien-Dindo grade 3 complication. 31 Pancreatic surgery specific complications as POPF, hepaticojejunostomy leak, chyle leak, DGE, and postpancreatectomy hemorrhage (PPH) were classified according to the International Study Group on Pancreatic Surgery (ISPGS) and International Study Group on Liver Surgery (ISGLS) definitions.…”

Section: Definitionsmentioning

confidence: 99%

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

Hilst

Rooij

Boezem

et al. 2019

HPB

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Background: Laparoscopic pancreatoduodenectomy with open reconstruction (LPD-OR) has been suggested to lower the rate of postoperative pancreatic fistula reported after laparoscopic pancreatoduodenectomy with laparoscopic reconstruction (LPD). Propensity score matched studies are, lacking. Methods: This is a multicenter prospective cohort study including patients from 7 Dutch centers between 2014-2018. Patients undergoing LPD-OR were matched LPD patients in a 1:1 ratio based on propensity scores. Main outcomes were postoperative pancreatic fistulas (POPF) grade B/C and Clavien-Dindo grade 3 complications. Results: A total of 172 patients were included, involving the first procedure for all centers. All 56 patients after LPD-OR could be matched to a patient undergoing LPD. With LPD-OR, the unplanned conversion rate was 21% vs. 9% with LPD (P < 0.001). Median blood loss (300 vs. 400 mL, P = 0.85), operative time (401 vs. 378 min, P = 0.62) and hospital stay (10 vs. 12 days, P = 0.31) were comparable for LPD-OR vs. LPD, as were Clavien-Dindo grade 3 complications (38% vs. 52%, P = 0.13), POPF grade B/C (23% vs. 21%, P = 0.82), and 90-day mortality (4% vs. 4%, P > 0.99). Conclusion: In this propensity matched cohort performed early in the learning curve, no benefit was found for LPD-OR, as compared to LPD.

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Standardizing terminology for minimally invasive pancreatic resection

Cited by 44 publications

References 46 publications

Minimally invasive versus open pancreatoduodenectomy (LEOPARD-2): study protocol for a randomized controlled trial

Minimally invasive versus open pancreatoduodenectomy (LEOPARD-2): study protocol for a randomized controlled trial

Multicentre observational cohort study of implementation and outcomes of laparoscopic distal pancreatectomy

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

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