Robot-assisted versus laparoscopic pancreatoduodenectomy: a pan-European multicenter propensity-matched study.

Autor: Emmen AMLH; Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy; Amsterdam UMC, location University of Amsterdam, Department of Surgery, the Netherlands; Cancer Center Amsterdam, the Netherlands. Electronic address: http://www.twitter.com/AnoukEmmen., Zwart MJW; Amsterdam UMC, location University of Amsterdam, Department of Surgery, the Netherlands; Cancer Center Amsterdam, the Netherlands. Electronic address: http://www.twitter.com/mauricezwart., Khatkov IE; Department of Surgery, Moscow Clinical Scientific Center, Russia., Boggi U; Division of General and Transplant Surgery, University of Pisa, Italy., Groot Koerkamp B; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands., Busch OR; Amsterdam UMC, location University of Amsterdam, Department of Surgery, the Netherlands; Cancer Center Amsterdam, the Netherlands., Saint-Marc O; Service de Chirurgie Digestive, Endocrinienne et Thoracique, Center Hospitalier Universitaire Orleans, France., Dokmak S; Department of HPB surgery and liver transplantation, Beaujon Hospital, Clichy, France. University Paris Cité., Molenaar IQ; Department of Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital and University Medical Center, the Netherlands., D'Hondt M; Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital Kortrijk, Belgium., Ramera M; Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy., Keck T; Clinic for Surgery, University of Schleswig-Holstein Campus Lübeck, Germany., Ferrari G; Department of Oncological and Minimally Invasive Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Luyer MDP; Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands., Moraldi L; Department of Oncology and Robotic Surgery, Careggi University Hospital, Florence, Italy., Ielpo B; Department of Surgery, HPB unit, University Mar Hospital, Parc Salut, Barcelona, Spain., Wittel U; Department of Surgery, University of Freiburg, Germany., Souche FR; Department de Chirurgie Digestive (A), Mini-invasive et Oncologigue, Hôspital Saint-Eloi, Montpellier, France., Hackert T; Dept. of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Germany., Lips D; Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands., Can MF; Private HPB Surgery Clinic Sogutozu, Ankara, Turkiye., Bosscha K; Department of Surgery, Jeroen Bosch Ziekenhuis, s-Hertogenbosch, the Netherlands., Fara R; Department of Surgery, Hôpital Européen Marseille, France., Festen S; Department of Surgery, OLVG, Amsterdam, the Netherlands., van Dieren S; Amsterdam UMC, location University of Amsterdam, Department of Surgery, the Netherlands; Cancer Center Amsterdam, the Netherlands., Coratti A; Department of Oncology and Robotic Surgery, Careggi University Hospital, Florence, Italy., De Hingh I; Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands., Mazzola M; Department of Oncological and Minimally Invasive Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Wellner U; Clinic for Surgery, University of Schleswig-Holstein Campus Lübeck, Germany., De Meyere C; Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital Kortrijk, Belgium., van Santvoort HC; Department of Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital and University Medical Center, the Netherlands., Aussilhou B; Department of HPB surgery and liver transplantation, Beaujon Hospital, Clichy, France. University Paris Cité., Ibenkhayat A; Service de Chirurgie Digestive, Endocrinienne et Thoracique, Center Hospitalier Universitaire Orleans, France., de Wilde RF; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands., Kauffmann EF; Division of General and Transplant Surgery, University of Pisa, Italy., Tyutyunnik P; Department of Surgery, Moscow Clinical Scientific Center, Russia., Besselink MG; Amsterdam UMC, location University of Amsterdam, Department of Surgery, the Netherlands; Cancer Center Amsterdam, the Netherlands. Electronic address: m.g.besselink@amsterdamUMC.nl., Abu Hilal M; Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy. Electronic address: abuhilal9@gmail.com.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2024 Jun; Vol. 175 (6), pp. 1587-1594. Date of Electronic Publication: 2024 Apr 03.
DOI: 10.1016/j.surg.2024.02.015
Abstrakt: Background: The use of robot-assisted and laparoscopic pancreatoduodenectomy is increasing, yet large adjusted analyses that can be generalized internationally are lacking. This study aimed to compare outcomes after robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy in a pan-European cohort.
Methods: An international multicenter retrospective study including patients after robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy from 50 centers in 12 European countries (2009-2020). Propensity score matching was performed in a 1:1 ratio. The primary outcome was major morbidity (Clavien-Dindo ≥III).
Results: Among 2,082 patients undergoing minimally invasive pancreatoduodenectomy, 1,006 underwent robot-assisted pancreatoduodenectomy and 1,076 laparoscopic pancreatoduodenectomy. After matching 812 versus 812 patients, the rates of major morbidity (31.9% vs 29.6%; P = .347) and 30-day/in-hospital mortality (4.3% vs 4.6%; P = .904) did not differ significantly between robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy, respectively. Robot-assisted pancreatoduodenectomy was associated with a lower conversion rate (6.7% vs 18.0%; P < .001) and higher lymph node retrieval (16 vs 14; P = .003). Laparoscopic pancreatoduodenectomy was associated with shorter operation time (446 minutes versus 400 minutes; P < .001), and lower rates of postoperative pancreatic fistula grade B/C (19.0% vs 11.7%; P < .001), delayed gastric emptying grade B/C (21.4% vs 7.4%; P < .001), and a higher R0-resection rate (73.2% vs 84.4%; P < .001).
Conclusion: This European multicenter study found no differences in overall major morbidity and 30-day/in-hospital mortality after robot-assisted pancreatoduodenectomy compared with laparoscopic pancreatoduodenectomy. Further, laparoscopic pancreatoduodenectomy was associated with a lower rate of postoperative pancreatic fistula, delayed gastric emptying, wound infection, shorter length of stay, and a higher R0 resection rate than robot-assisted pancreatoduodenectomy. In contrast, robot-assisted pancreatoduodenectomy was associated with a lower conversion rate and a higher number of retrieved lymph nodes as compared with laparoscopic pancreatoduodenectomy.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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