Nationwide use and Outcome of Minimally Invasive Distal Pancreatectomy in IDEAL Stage IV following a Training Program and Randomized Trial. (2024)

Affiliation

• Korrel M; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam.
• van Hilst J; Cancer Center Amsterdam.
• Bosscha K; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam.
• Busch ORC; Department of Surgery, OLVG Oost, Amsterdam.
• Daams F; Department of Surgery, Jeroen Bosch Hospital, Den Bosch.
• van Dam R; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam.
• van Eijck CHJ; Cancer Center Amsterdam.
• Festen S; Cancer Center Amsterdam.
• Groot Koerkamp B; Amsterdam UMC, location Vrije Universiteit, Department of Surgery, Amsterdam.
• van der Harst E; Department of Surgery, Maastricht University Medical Centre, Maastricht.
• Lips DJ; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam.
• Luyer MD; Department of Surgery, OLVG Oost, Amsterdam.
• de Meijer VE; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam.
• Mieog JSD; Department of Surgery, Maasstad Hospital, Rotterdam.
• Molenaar IQ; Department of Surgery, Medisch Spectrum Twente, Enschede.
• Patijn GA; Department of Surgery, Catharina Hospital, Eindhoven.
• van Santvoort HC; Department of Surgery, University of Groningen and University Medical Centre Groningen, Groningen.
• van der Schelling GP; Department of Surgery, Leiden University Medical Center, Leiden.
• Stommel MWJ; Department of Surgery, UMC Utrecht Cancer Centre, St Antonius Hospital Nieuwegein; Regional Academic Cancer Centre Utrecht, Utrecht.
• Besselink MG; Department of Surgery, Isala, Zwolle.

ABSTRACT

OBJECTIVE:

To assess the nationwide long-term uptake and outcomes of minimally invasive distal pancreatectomy (MIDP) after a nationwide training program and randomized trial.

BACKGROUND:

Two randomized trials demonstrated the superiority of MIDP over open distal pancreatectomy (ODP) in terms of functional recovery and hospital stay. Data on implementation of MIDP on a nationwide level are lacking.

METHODS:

Nationwide audit-based study including consecutive patients after MIDP and ODP in 16 centers in the Dutch Pancreatic Cancer Audit (2014 to 2021). The cohort was divided into three periods early implementation, during the LEOPARD randomized trial, and late implementation. Primary endpoints were MIDP implementation rate and textbook outcome.

RESULTS:

Overall, 1496 patients were included with 848 MIDP (56.5%) and 648 ODP (43.5%). From the early to the late implementation period, the use of MIDP increased from 48.6% to 63.0% and of robotic MIDP from 5.5% to 29.7% ( P <0.001). The overall use of MIDP (45% to 75%) and robotic MIDP (1% to 84%) varied widely between centers ( P <0.001). In the late implementation period, 5/16 centers performed >75% of procedures as MIDP. After MIDP, in-hospital mortality and textbook outcome remained stable over time. In the late implementation period, ODP was more often performed in ASA score III-IV (24.9% vs. 35.7%, P =0.001), pancreatic cancer (24.2% vs. 45.9%, P <0.001), vascular involvement (4.6% vs. 21.9%, P <0.001), and multivisceral involvement (10.5% vs. 25.3%, P <0.001). After MIDP, shorter hospital stay (median 7 vs. 8d, P <0.001) and less blood loss (median 150 vs. 500mL, P <0.001), but more grade B/C postoperative pancreatic fistula (24.4% vs. 17.2%, P =0.008) occurred as compared to ODP.

CONCLUSION:

A sustained nationwide implementation of MIDP after a successful training program and randomized trial was obtained with satisfactory outcomes. Future studies should assess the considerable variation in the use of MIDP between centers and, especially, robotic MIDP.