Robotic distal pancreatectomy, a novel standard of care? First benchmark values for surgical outcomes from 14 international expert centers
Rattachement africain : ch, dk, fr, de, it, gb, us, nl. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
Abstract Objective Robotic distal pancreatectomy (DP) is emerging as the preferred treatment for body and tail tumors of the pancreas. To enable conclusive comparisons with the standard open or laparoscopic approaches and robotic surgery among centers, novel benchmark outcome values are urgently needed. Therefore, the aim of this study was to identify benchmark values from expert centers beyond the learning curve. Methods This multicenter study analyzed outcomes from consecutive patients undergoing robotic DP for resectable malignant or benign lesions from 14 international expert centers. After the learning curve, defined as the first 10 cases of robotic DP, all consecutive patients were included from the start of the program up to June 2020 with a minimum follow-up of 1 year. Benchmark patients were those without significant comorbidities including obesity (BMI >35 kg/m2) cardiac disease, chronic pulmonary disease. Benchmark cutoff values were derived from the 75th or the 25th percentile of the median values of all benchmark centers. Results After reaching the learning curve, 289 (47%) of a total of 614 consecutive patients qualified as benchmark cases. The proportion of benchmark patients varied between 24%-64% per center. Benchmark cut-offs showed a low 6 month- postoperative mortality (<0.6%), but high overall morbidity (<58.3%). Benchmark cutoffs for operative time (<300 min), conversion rate (<3%), clinically relevant pancreatic fistulas (<26.9%), CCI at 90-days (<14.8), hospital stay (<7 days) and readmission rate (<22.9%). Benchmark cut-offs for complications remained unchanged after 3 months follow-up. For ductal adenocarcinoma benchmark cutoffs for number of lymph nodes were > 19 with an R0 resection rate of > 85%, and an overall survival of >86% and >52% after 1- and 5-years, respectively. Centers with a low cohort of benchmark patients (more difficult cases) had less clinically relevant pancreatic fistula (9% vs. 23%) and less overall complications (32% vs. 48%). Conclusion This benchmark analysis sets novel reference values for robotic DP, indicating favorable outcomes as compared to laparoscopic and open DP. These references values may serve for quality control of surgery in centers embarking in robotic DP, and include the procedure in the standard of care.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Robotic distal pancreatectomy, a novel standard of care? First benchmark values for surgical outcomes from 14 international expert centers
- Date Crossref
- 31/05/2022
- Éditeur
- Oxford University Press (OUP)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University Hospital Zurich Department of Visceral and Transplant Surgery pays non établi dans la noticeÉtablissement de santé
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Copenhagen University Hospital Department of Surgery and Transplantation pays non établi dans la noticeÉtablissement de santé
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Rigshospitalet pays non établi dans la noticeÉtablissement de santé
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Centre hospitalier universitaire d'Orléans pays non établi dans la noticeÉtablissement de santé
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University Hospital Schleswig-Holstein pays non établi dans la noticeÉtablissement de santé
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University of Lübeck pays non établi dans la noticeUniversité ou école supérieure
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Ospedale Misericordia - Grosseto pays non établi dans la noticeÉtablissement de santé
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Durham University pays non établi dans la noticeUniversité ou école supérieure
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University of Illinois Chicago pays non établi dans la noticeUniversité ou école supérieure
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University of Chicago Medical Center pays non établi dans la noticeÉtablissement de santé
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Heidelberg University pays non établi dans la noticeUniversité ou école supérieure
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University Hospital Heidelberg Department of Surgery and Transplantation pays non établi dans la noticeÉtablissement de santé
Department of Visceral and Transplant Surgery — University Hospital Zurich, Department of Surgery and Transplantation — Copenhagen University Hospital et Rigshospitalet, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.