Novel Benchmarks for Robotic Whipple Surgery - A Global Multicenter Cohort Study
Rattachement africain : ch, us, fr, jp, pt, it, hk, sg, es, kr, br. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
Abstract Background Robotic Whipple holds the promise to overcome safety concerns associated with laparoscopy, paving the way for widespread implementation of minimal-invasive surgery in this complex procedure. However, randomized data comparing robot vs. open Whipple demonstrate more pancreas-specific complications and R1-resections in the robotic arm. Recent international consensus identified establishing benchmarks as critical to ensure safe adoption of the robot. Benchmarking is a validated quality improvement tool, enabling comparison of surgical performance. Aims The aim was to define benchmarks for outcome parameters in robotic Whipple. Methods We analyzed consecutive patients undergoing robotic Whipple from January 2020 until December 2023 in 11 centers across 4 continents, with a minimum one-year follow-up. Centers had to perform ≥15 cases/year and have mounted their learning curve. Benchmark criteria included benign or resectable malignant disease without neoadjuvant therapy, arterial resection, major co-morbidities, or significant previous abdominal surgery. Medians across centers represented benchmark cutoffs. Results Eleven centers performed 1’037 Whipple procedures, of which 603 (58%) were benchmark cases. One third (n=192) were pancreatic ductal adenocarcinoma (PDAC) patients. Key benchmarks at 6 months included ≤1.2% mortality, ≤24.2% major complications, and ≤ 8.7 points Comprehensive Complication Index®. Pancreas-specific cutoffs included ≤13.0% postoperative pancreatic fistula (POPF) B/C and ≤3.4% post-pancreatectomy hemorrhage B/C, with 100% R0-resection and ≥19 harvested lymph nodes in PDAC patients. One-year actuarial overall and recurrence-free survival was 87% and 77%. In the entire cohort POPF B/C occurred in 16% (n=195). Independent POPF predictors included duct diameter ≤4mm (OR 1.79 95%CI [1.27-2.55]), anticoagulation (OR 3.68 95%CI [2.14-6.24]), and indication other than PDAC (OR 3.17, 95%CI [2.13-4.85]). Conclusion This study establishes benchmarks for key outcomes in robotic Whipple, demonstrating oncologic adequacy and morbidity comparable to open surgery. Risk factors for POPF in open surgery also hold true in the robotic approach.
Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.
Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Novel Benchmarks for Robotic Whipple Surgery - A Global Multicenter Cohort Study
- Date Crossref
- 01/05/2025
- 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 of Zurich Department of Surgery and Transplantation pays non établi dans la noticeUniversité ou école supérieure
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ETH Zurich pays non établi dans la noticeUniversité ou école supérieure
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Wyss Zurich Translational Center pays non établi dans la noticeStructure de recherche
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WinnMed pays non établi dans la noticeOrganisation à but non lucratif
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Prevention Institute pays non établi dans la noticeOrganisation à but non lucratif
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Hôpitaux Universitaires Henri-Mondor pays non établi dans la noticeÉtablissement de santé
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University of California Department of Surgery pays non établi dans la noticeUniversité ou école supérieure
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Hôpital Civil Division of Hepato-Biliary and Pancreatic Surgery 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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The University of Texas Southwestern Medical Center Department of Surgery pays non établi dans la noticeÉtablissement de santé
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Tokyo Medical University Department of Gastrointestinal and Pediatric Surgery pays non établi dans la noticeUniversité ou école supérieure
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Hospital Curry Cabral pays non établi dans la noticeÉtablissement de santé
Department of Surgery and Transplantation — University of Zurich, ETH Zurich et Wyss Zurich Translational Center, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.