The impact of unplanned conversion to an open procedure during minimally invasive pancreatectomy

Stiles, Zachary E.; Dickson, Paxton V.; Deneve, Jeremiah L.; Glazer, Evan S.; Dong, Lei; Wan, Jim Y.; Behrman, Stephen W.

doi:10.1016/j.jss.2018.02.028

Cited by 33 publications

(45 citation statements)

References 35 publications

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“…There is evidence that converted patients will have a higher postoperative CCI than those patients randomised to the ODP group. 35 However, this evidence results from retrospective data analysis, leaving room for bias and deviating observations in our prospective randomised study. In any case, the AT set is an important complement to the two common (and recommended) analysis sets here.…”

Section: Methodsmentioning

confidence: 85%

Protocol for a randomised controlled trial to compare postoperative complications between minimally invasive and open DIStal PAnCreaTectomy (DISPACT-2 trial)

et al. 2021

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IntroductionIn recent years, minimally invasive distal pancreatectomy (MIDP) has been used with increasing frequency to accelerate patient recovery. Distal pancreatectomy has an overall morbidity rate of 30%–40%. The known advantages of minimally invasive techniques must be rigorously compared with those of open surgery before they can be completely implemented into clinical practice.Methods and analysisDISPACT-2 is a multicentre randomised controlled trial comparing minimally invasive (conventional laparoscopic or robotic assisted) with open distal pancreatic resection in patients undergoing elective surgery for benign as well as malign diseases of the pancreatic body and tail. After screening for eligibility and obtaining informed consent, a total of 294 adult patients will be preoperatively randomised in a 1:1 ratio. The primary hypothesis is that MIDP is non-inferior to open distal pancreatectomy in terms of postoperative mortality and morbidity expressed as the Comprehensive Complication Index (CCI) within 3 months after index operation, with a non-inferiority margin of 7.5 CCI points. Secondary endpoints include pancreas-specific complications, oncological safety and patient reported outcomes. Follow-up for each individual patient will be 2 years.Ethics and disseminationThe DISPACT-2 trial has been approved by the Ethics Committee of the medical faculty of Heidelberg University (S-693/2017). Results of the primary endpoint will be available in 2024 and will be published at national and international meetings. Full results will be made available in an open access, peer-reviewed journal. The website www.dispact.de contains up-to-date information regarding the trial.Trial registration numberDRKS00014011

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Section: Methodsmentioning

confidence: 85%

Protocol for a randomised controlled trial to compare postoperative complications between minimally invasive and open DIStal PAnCreaTectomy (DISPACT-2 trial)

et al. 2021

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Section: Proposal Potential Indicationsmentioning

confidence: 99%

“…Only expert surgeons are responsible for this advanced stage of the pancreatic cancer. These cases mostly will result in elective conversion to open for procedural safety and curative resection [95]. cancer, surgical approach should be allowed only when surgeons' technical feasibility can obtain the appropriate surgical extent for margin-negative resection.…”

Section: Proposal Potential Indicationsmentioning

confidence: 99%

Is Laparoscopic Pancreaticoduodenectomy Feasible for Pancreatic Ductal Adenocarcinoma?

Kang

Lee

2020

Cancers

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Margin-negative radical pancreatectomy is the essential condition to obtain long-term survival of patients with pancreatic cancer. With the investigation for early diagnosis, introduction of potent chemotherapeutic agents, application of neoadjuvnat chemotherapy, advancement of open and laparoscopic surgical techniques, mature perioperative management, and patients’ improved general conditions, survival of the resected pancreatic cancer is expected to be further improved. According to the literatures, laparoscopic pancreaticoduodenectomy (LPD) is also thought to be good alternative strategy in managing well-selected resectable pancreatic cancer. LPD with combined vascular resection is also feasible, but only expert surgeons should handle these challenging cases. LPD for pancreatic cancer should be determined based on surgeons’ proficiency to fulfil the goals of the patient’s safety and oncologic principles.

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“…According to the analysis of the American College of Surgeons National Surgical Quality Improvement Program and National Cancer Database, compared to LDP, RDP has longer operation time (46) and less conversion rate, but there was no significant difference in their perioperative outcomes (44,47,48). Moreover, when compared to ODP, RDP had longer operation time, lesser blood loss, and lesser postoperative bleeding (46).…”

Section: Recommendation 2: Rdp Is As Safe and Feasible As Laparoscopic Dp The Intraoperative Blood Loss Length Of Hospital Stay (Los) Ovementioning

confidence: 99%

International consensus statement on robotic pancreatic surgery

Liu

Wakabayashi

Palanivelu

et al. 2019

Hepatobiliary Surg. Nutr.

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The robotic surgical system has been applied to various types of pancreatic surgery. However, controversies exist regarding a variety of factors including the safety, feasibility, efficacy, and cost-effectiveness of robotic surgery. This study aimed to evaluate the current status of robotic pancreatic surgery and put forth experts' consensus and recommendations to promote its development. Based on the WHO Handbook for Guideline Development, a Consensus Steering Group* and a Consensus Development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations. The GRADE Grid method and Delphi vote were used to formulate the recommendations. A total of 19 topics were analyzed. The first 16 recommendations were generated by GRADE using an evidence-based method (EBM) and focused on the safety, feasibility, indication, techniques, certification of the robotic surgeon, and cost-effectiveness of robotic pancreatic surgery. The remaining three recommendations were based on literature review and expert panel opinion due to insufficient EBM results. Since the current amount of evidence was low/meager as evaluated by the GRADE method, further randomized controlled trials (RCTs) are needed in the future to validate these recommendations.

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The impact of unplanned conversion to an open procedure during minimally invasive pancreatectomy

Cited by 33 publications

References 35 publications

Protocol for a randomised controlled trial to compare postoperative complications between minimally invasive and open DIStal PAnCreaTectomy (DISPACT-2 trial)

Protocol for a randomised controlled trial to compare postoperative complications between minimally invasive and open DIStal PAnCreaTectomy (DISPACT-2 trial)

Is Laparoscopic Pancreaticoduodenectomy Feasible for Pancreatic Ductal Adenocarcinoma?

International consensus statement on robotic pancreatic surgery

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