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

Anouk M.L.H. Emmen; Maurice J.W. Zwart; European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS); Igor E. Khatkov; Ugo Boggi; Bas Groot Koerkamp; Olivier R. Busch; Olivier Saint-Marc; Safi Dokmak; I. Quintus Molenaar; Mathieu D'Hondt; Marco Ramera; Tobias Keck; Giovanni Ferrari; Misha D.P. Luyer; Luca Moraldi; Benedetto Ielpo; Uwe Wittel; Francois Regis Souche; Thilo Hackert; Daan Lips; Mehmet Fatih Can; Koop Bosscha; Regis Fara; Sebastiaan Festen; Susan van Dieren; Andrea Coratti; Ignace De Hingh; Michele Mazzola; Ulrich Wellner; Celine De Meyere; Hjalmar C. van Santvoort; Béatrice Aussilhou; Abdallah Ibenkhayat; Roeland F. de Wilde; Emanuele F. Kauffmann; Pavel Tyutyunnik; Marc G. Besselink; Mohammad Abu Hilal; Alberto Manzoni; Martina Guerra; Freek Daams; Geert Kazemier; Roman Izrailov; Mikhail Efanov; Niccolò Napoli; Michael Ginesini; Marie Cappelle; Roel Haen; Romain Quetel; Marco Pucci

doi:10.1016/j.surg.2024.02.015

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

Anouk M.L.H. Emmen, Maurice J.W. Zwart, European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS), Igor E. Khatkov, Ugo Boggi, Bas Groot Koerkamp, Olivier R. Busch, Olivier Saint-Marc, Safi Dokmak, I. Quintus Molenaar, Mathieu D'Hondt, Marco Ramera, Tobias Keck, Giovanni Ferrari, Misha D.P. Luyer, Luca Moraldi, Benedetto Ielpo, Uwe Wittel, Francois Regis Souche, Thilo HackertDaan Lips, Mehmet Fatih Can, Koop Bosscha, Regis Fara, Sebastiaan Festen, Susan van Dieren, Andrea Coratti, Ignace De Hingh, Michele Mazzola, Ulrich Wellner, Celine De Meyere, Hjalmar C. van Santvoort, Béatrice Aussilhou, Abdallah Ibenkhayat, Roeland F. de Wilde, Emanuele F. Kauffmann, Pavel Tyutyunnik, Marc G. Besselink^*, Mohammad Abu Hilal^*, Alberto Manzoni, Martina Guerra, Freek Daams, Geert Kazemier, Roman Izrailov, Mikhail Efanov, Niccolò Napoli, Michael Ginesini, Marie Cappelle, Roel Haen, Romain Quetel, Marco Pucci

^*Corresponding author for this work

Surgery

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

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.

Original language	English
Pages (from-to)	1587-1594
Number of pages	8
Journal	Surgery (United States)
Volume	175
Issue number	6
DOIs	https://doi.org/10.1016/j.surg.2024.02.015
Publication status	Published - Jun 2024

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Publisher Copyright:
© 2024 The Authors

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Emmen, A. M. L. H., Zwart, M. J. W., European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS), Khatkov, I. E., Boggi, U., Groot Koerkamp, B., Busch, O. R., Saint-Marc, O., Dokmak, S., Molenaar, I. Q., D'Hondt, M., Ramera, M., Keck, T., Ferrari, G., Luyer, M. D. P., Moraldi, L., Ielpo, B., Wittel, U., Souche, F. R., ... Pucci, M. (2024). Robot-assisted versus laparoscopic pancreatoduodenectomy: a pan-European multicenter propensity-matched study. Surgery (United States), 175(6), 1587-1594. https://doi.org/10.1016/j.surg.2024.02.015

@article{8a9d3ca8aedf44aa8c86c33fa7bc56cd,

title = "Robot-assisted versus laparoscopic pancreatoduodenectomy: a pan-European multicenter propensity-matched study",

abstract = "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.",

author = "Emmen, \{Anouk M.L.H.\} and Zwart, \{Maurice J.W.\} and \{European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)\} and Khatkov, \{Igor E.\} and Ugo Boggi and \{Groot Koerkamp\}, Bas and Busch, \{Olivier R.\} and Olivier Saint-Marc and Safi Dokmak and Molenaar, \{I. Quintus\} and Mathieu D'Hondt and Marco Ramera and Tobias Keck and Giovanni Ferrari and Luyer, \{Misha D.P.\} and Luca Moraldi and Benedetto Ielpo and Uwe Wittel and Souche, \{Francois Regis\} and Thilo Hackert and Daan Lips and Can, \{Mehmet Fatih\} and Koop Bosscha and Regis Fara and Sebastiaan Festen and \{van Dieren\}, Susan and Andrea Coratti and \{De Hingh\}, Ignace and Michele Mazzola and Ulrich Wellner and \{De Meyere\}, Celine and \{van Santvoort\}, \{Hjalmar C.\} and B{\'e}atrice Aussilhou and Abdallah Ibenkhayat and \{de Wilde\}, \{Roeland F.\} and Kauffmann, \{Emanuele F.\} and Pavel Tyutyunnik and Besselink, \{Marc G.\} and \{Abu Hilal\}, Mohammad and Alberto Manzoni and Martina Guerra and Freek Daams and Geert Kazemier and Roman Izrailov and Mikhail Efanov and Niccol{\`o} Napoli and Michael Ginesini and Marie Cappelle and Roel Haen and Romain Quetel and Marco Pucci",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors",

year = "2024",

month = jun,

doi = "10.1016/j.surg.2024.02.015",

language = "English",

volume = "175",

pages = "1587--1594",

journal = "Surgery (United States)",

issn = "0039-6060",

publisher = "Elsevier Inc.",

number = "6",

}

Emmen, AMLH, Zwart, MJW, European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS), Khatkov, IE, Boggi, U, Groot Koerkamp, B, Busch, OR, Saint-Marc, O, Dokmak, S, Molenaar, IQ, D'Hondt, M, Ramera, M, Keck, T, Ferrari, G, Luyer, MDP, Moraldi, L, Ielpo, B, Wittel, U, Souche, FR, Hackert, T, Lips, D, Can, MF, Bosscha, K, Fara, R, Festen, S, van Dieren, S, Coratti, A, De Hingh, I, Mazzola, M, Wellner, U, De Meyere, C, van Santvoort, HC, Aussilhou, B, Ibenkhayat, A, de Wilde, RF, Kauffmann, EF, Tyutyunnik, P, Besselink, MG, Abu Hilal, M, Manzoni, A, Guerra, M, Daams, F, Kazemier, G, Izrailov, R, Efanov, M, Napoli, N, Ginesini, M, Cappelle, M , Haen, R, Quetel, R & Pucci, M 2024, 'Robot-assisted versus laparoscopic pancreatoduodenectomy: a pan-European multicenter propensity-matched study', Surgery (United States), vol. 175, no. 6, pp. 1587-1594. https://doi.org/10.1016/j.surg.2024.02.015

Robot-assisted versus laparoscopic pancreatoduodenectomy: a pan-European multicenter propensity-matched study. / Emmen, Anouk M.L.H.; Zwart, Maurice J.W.; European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS) et al.
In: Surgery (United States), Vol. 175, No. 6, 06.2024, p. 1587-1594.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Robot-assisted versus laparoscopic pancreatoduodenectomy

T2 - a pan-European multicenter propensity-matched study

AU - Emmen, Anouk M.L.H.

AU - Zwart, Maurice J.W.

AU - European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)

AU - Khatkov, Igor E.

AU - Boggi, Ugo

AU - Groot Koerkamp, Bas

AU - Busch, Olivier R.

AU - Saint-Marc, Olivier

AU - Dokmak, Safi

AU - Molenaar, I. Quintus

AU - D'Hondt, Mathieu

AU - Ramera, Marco

AU - Keck, Tobias

AU - Ferrari, Giovanni

AU - Luyer, Misha D.P.

AU - Moraldi, Luca

AU - Ielpo, Benedetto

AU - Wittel, Uwe

AU - Souche, Francois Regis

AU - Hackert, Thilo

AU - Lips, Daan

AU - Can, Mehmet Fatih

AU - Bosscha, Koop

AU - Fara, Regis

AU - Festen, Sebastiaan

AU - van Dieren, Susan

AU - Coratti, Andrea

AU - De Hingh, Ignace

AU - Mazzola, Michele

AU - Wellner, Ulrich

AU - De Meyere, Celine

AU - van Santvoort, Hjalmar C.

AU - Aussilhou, Béatrice

AU - Ibenkhayat, Abdallah

AU - de Wilde, Roeland F.

AU - Kauffmann, Emanuele F.

AU - Tyutyunnik, Pavel

AU - Besselink, Marc G.

AU - Abu Hilal, Mohammad

AU - Manzoni, Alberto

AU - Guerra, Martina

AU - Daams, Freek

AU - Kazemier, Geert

AU - Izrailov, Roman

AU - Efanov, Mikhail

AU - Napoli, Niccolò

AU - Ginesini, Michael

AU - Cappelle, Marie

AU - Haen, Roel

AU - Quetel, Romain

AU - Pucci, Marco

PY - 2024/6

Y1 - 2024/6

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85189684394&partnerID=8YFLogxK

U2 - 10.1016/j.surg.2024.02.015

DO - 10.1016/j.surg.2024.02.015

M3 - Article

C2 - 38570225

AN - SCOPUS:85189684394

SN - 0039-6060

VL - 175

SP - 1587

EP - 1594

JO - Surgery (United States)

JF - Surgery (United States)

IS - 6

ER -

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

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