The PD-ROBOSCORE: A difficulty score for robotic pancreatoduodenectomy.

Autor: Napoli N; Division of General and Transplant Surgery, University of Pisa, Italy., Cacace C; Division of General and Transplant Surgery, University of Pisa, Italy., Kauffmann EF; Division of General and Transplant Surgery, University of Pisa, Italy., Jones L; Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy; Department of Surgery, Amsterdam UMC, University of Amsterdam, Netherlands; Cancer Center Amsterdam, Netherlands., Ginesini M; Division of General and Transplant Surgery, University of Pisa, Italy., Gianfaldoni C; Division of General and Transplant Surgery, University of Pisa, Italy., Salamone A; Division of General and Transplant Surgery, University of Pisa, Italy., Asta F; Division of General and Transplant Surgery, University of Pisa, Italy., Ripolli A; Division of General and Transplant Surgery, University of Pisa, Italy., Di Dato A; Division of General and Transplant Surgery, University of Pisa, Italy., Busch OR; Department of Surgery, Amsterdam UMC, University of Amsterdam, Netherlands; Cancer Center Amsterdam, Netherlands., Cappelle ML; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands., Chao YJ; Department of Surgery, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan., de Wilde RF; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands., Hackert T; Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Germany., Jang JY; Department of Hepatobiliary and Pancreatic Surgery, Seoul National University College of Medicine, Seoul, South Korea., Koerkamp BG; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands., Kwon W; Department of Hepatobiliary and Pancreatic Surgery, Seoul National University College of Medicine, Seoul, South Korea., Lips D; Department of Surgery, Medisch Spectrum Twente, Enschede, Netherlands., Luyer MDP; Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, Netherlands., Nickel F; Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Germany., Saint-Marc O; Department of Surgery, Centre Hospitalier Regional D'Orleans, Orléans, France., Shan YS; Department of Surgery, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan., Shen B; Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China., Vistoli F; Division of General and Transplant Surgery, University of Pisa, Italy., Besselink MG; Department of Surgery, Amsterdam UMC, University of Amsterdam, Netherlands; Cancer Center Amsterdam, Netherlands., Hilal MA; Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy., Boggi U; Division of General and Transplant Surgery, University of Pisa, Italy. Electronic address: u.boggi@med.unipi.it.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2023 Jun; Vol. 173 (6), pp. 1438-1446. Date of Electronic Publication: 2023 Mar 25.
DOI: 10.1016/j.surg.2023.02.020
Abstrakt: Background: Difficulty scoring systems are important for the safe, stepwise implementation of new procedures. We designed a retrospective observational study for building a difficulty score for robotic pancreatoduodenectomy.
Methods: The difficulty score (PD-ROBOSCORE) aims at predicting severe postoperative complications after robotic pancreatoduodenectomy. The PD-ROBOSCORE was developed in a training cohort of 198 robotic pancreatoduodenectomies and was validated in an international multicenter cohort of 686 robotic pancreatoduodenectomies. Finally, all centers tested the model during the early learning curve (n = 300). Growing difficulty levels (low, intermediate, high) were defined using cut-off values set at the 33rd and 66th percentile (NCT04662346).
Results: Factors included in the final multivariate model were a body mass index of ≥25 kg/m 2 for males and ≥30 kg/m 2 for females (odds ratio:2.39; P < .0001), borderline resectable tumor (odd ratio:1.98; P < .0001), uncinate process tumor (odds ratio:1.69; P < .0001), pancreatic duct size <4 mm (odds ratio:1.59; P < .0001), American Society of Anesthesiologists class ≥3 (odds ratio:1.59; P < .0001), and hepatic artery originating from the superior mesenteric artery (odds ratio:1.43; P < .0001). In the training cohort, the absolute score value (odds ratio = 1.13; P = .0089) and difficulty groups (odds ratio = 2.35; P = .041) predicted severe postoperative complications. In the multicenter validation cohort, the absolute score value predicted severe postoperative complications (odds ratio = 1.16, P < .001), whereas the difficulty groups did not (odds ratio = 1.94, P = .082). In the learning curve cohort, both absolute score value (odds ratio:1.078, P = .04) and difficulty groups (odds ratio: 2.25, P = .017) predicted severe postoperative complications. Across all cohorts, a PD-ROBOSCORE of ≥12.51 doubled the risk of severe postoperative complications. The PD-ROBOSCORE score also predicted operative time, estimated blood loss, and vein resection. The PD-ROBOSCORE predicted postoperative pancreatic fistula, delayed gastric emptying, postpancreatectomy hemorrhage, and postoperative mortality in the learning curve cohort.
Conclusion: The PD-ROBOSCORE predicts severe postoperative complications after robotic pancreatoduodenectomy. The score is readily available via www.pancreascalculator.com.
(Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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