TY - JOUR
T1 - Learning curve stratified outcomes after robotic pancreatoduodenectomy
T2 - International multicenter experience
AU - Jones, Leia R.
AU - Zwart, Maurice J.W.
AU - International Consortium on Minimally Invasive Pancreatic Surgery (I-MIPS)
AU - de Graaf, Nine
AU - Wei, Kongyuan
AU - Qu, Liu
AU - Jiabin, Jin
AU - Ningzhen, Fu
AU - Wang, Shin E.
AU - Kim, Hongbeom
AU - Kauffmann, Emanuele F.
AU - de Wilde, Roeland F.
AU - Molenaar, I. Quintus
AU - Chao, Ying Jui
AU - Moraldi, Luca
AU - Saint-Marc, Olivier
AU - Nickel, Felix
AU - Peng, Cheng Ming
AU - Kang, Chang Moo
AU - Machado, Marcel
AU - Luyer, Misha D.P.
AU - Lips, Daan J.
AU - Bonsing, Bert A.
AU - Hackert, Thilo
AU - Shan, Yan Shen
AU - Groot Koerkamp, Bas
AU - Shyr, Yi Ming
AU - Shen, Baiyong
AU - Boggi, Ugo
AU - Liu, Rong
AU - Jang, Jin Young
AU - Besselink, Marc G.
AU - Abu Hilal, Mohammad
N1 - Publisher Copyright:
© 2024
PY - 2024/12
Y1 - 2024/12
N2 - Background: Robotic pancreatoduodenectomy is increasingly being implemented worldwide, with good results reported from individual expert centers. However, it is unclear to what extent outcomes will continue to improve during the learning curve, as large international studies are lacking. Methods: An international retrospective multicenter case series, including consecutive patients after robotic pancreatoduodenectomy from 18 centers in 8 countries in Europe, Asia, and South America until December 31, 2019, was conducted. A cumulative sum analysis was performed to determine the inflection points for the feasibility (operative time and blood loss) and proficiency (postoperative pancreatic fistula grade B/C and major morbidity) learning curves. Outcomes were compared in 3 groups on the basis of the learning curve inflection points. Results: Overall, 2,186 patients after robotic pancreatoduodenectomy were included. The feasibility learning curve was reached after 30–45 robotic pancreatoduodenectomy procedures and the proficiency learning curve after 90 robotic pancreatoduodenectomy procedures. These inflection points created 3 phases, which were associated with major morbidity (24.7%, 23.4%, and 12.3%, P < .001) but not 30-day mortality (2.1%, 2.0%, and 1.5%, P = .670). Other outcomes mostly continued to improve, including median operative time 432, 390, and 300 minutes (P < .0001), conversion 6.0%, 4.7%, and 2.7% (P = .002), bile leakage 7.2%, 4.1%, and 2.4% (P < .001), postpancreatectomy hemorrhage 6.5%, 6.1%, and 1.8% (n = 21) but not R0 resection (pancreatic ductal adenocarcinoma only) 78.5%, 73.9%, and 82.8% (P = .35), and 90-day mortality rate 3.1%, 3.5%, and 2.1% (P = .191). Centers performing >20 robotic pancreatoduodenectomies annually had lower rates of conversion, reoperation, and shorter median operative time as compared with centers performing 10–20 robotic pancreatoduodenectomies annually. Conclusion: This international multicenter study demonstrates that most outcomes of robotic pancreatoduodenectomy continued to improve during 3 learning curve phases without a negative effect on 90-day mortality. Randomized studies are needed in high-volume centers that have surpassed the first learning curves, to compare these outcomes with the open approach.
AB - Background: Robotic pancreatoduodenectomy is increasingly being implemented worldwide, with good results reported from individual expert centers. However, it is unclear to what extent outcomes will continue to improve during the learning curve, as large international studies are lacking. Methods: An international retrospective multicenter case series, including consecutive patients after robotic pancreatoduodenectomy from 18 centers in 8 countries in Europe, Asia, and South America until December 31, 2019, was conducted. A cumulative sum analysis was performed to determine the inflection points for the feasibility (operative time and blood loss) and proficiency (postoperative pancreatic fistula grade B/C and major morbidity) learning curves. Outcomes were compared in 3 groups on the basis of the learning curve inflection points. Results: Overall, 2,186 patients after robotic pancreatoduodenectomy were included. The feasibility learning curve was reached after 30–45 robotic pancreatoduodenectomy procedures and the proficiency learning curve after 90 robotic pancreatoduodenectomy procedures. These inflection points created 3 phases, which were associated with major morbidity (24.7%, 23.4%, and 12.3%, P < .001) but not 30-day mortality (2.1%, 2.0%, and 1.5%, P = .670). Other outcomes mostly continued to improve, including median operative time 432, 390, and 300 minutes (P < .0001), conversion 6.0%, 4.7%, and 2.7% (P = .002), bile leakage 7.2%, 4.1%, and 2.4% (P < .001), postpancreatectomy hemorrhage 6.5%, 6.1%, and 1.8% (n = 21) but not R0 resection (pancreatic ductal adenocarcinoma only) 78.5%, 73.9%, and 82.8% (P = .35), and 90-day mortality rate 3.1%, 3.5%, and 2.1% (P = .191). Centers performing >20 robotic pancreatoduodenectomies annually had lower rates of conversion, reoperation, and shorter median operative time as compared with centers performing 10–20 robotic pancreatoduodenectomies annually. Conclusion: This international multicenter study demonstrates that most outcomes of robotic pancreatoduodenectomy continued to improve during 3 learning curve phases without a negative effect on 90-day mortality. Randomized studies are needed in high-volume centers that have surpassed the first learning curves, to compare these outcomes with the open approach.
UR - https://www.scopus.com/pages/publications/85201492235
U2 - 10.1016/j.surg.2024.05.044
DO - 10.1016/j.surg.2024.05.044
M3 - Article
C2 - 39164152
AN - SCOPUS:85201492235
SN - 0039-6060
VL - 176
SP - 1721
EP - 1729
JO - Surgery (United States)
JF - Surgery (United States)
IS - 6
ER -