The PD-ROBOSCORE: A difficulty score for robotic pancreatoduodenectomy

Niccolò Napoli, Concetta Cacace, International Consortium on Minimally Invasive Pancreatic Surgery (I-MIPS), Emanuele F. Kauffmann, Leia Jones, Michael Ginesini, Cesare Gianfaldoni, Alice Salamone, Fabio Asta, Allegra Ripolli, Armando Di Dato, Olivier R. Busch, Marie L. Cappelle, Ying Jui Chao, Roeland F. de Wilde, Thilo Hackert, Jin Young Jang, Bas Groot Koerkamp, Wooil Kwon, Daan LipsMisha D.P. Luyer, Felix Nickel, Olivier Saint-Marc, Yan Shen Shan, Baiyong Shen, Fabio Vistoli, Marc G. Besselink, Mohammad Abu Hilal, Ugo Boggi*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Scopus)
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Abstract

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/m2 for males and ≥30 kg/m2 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

Original languageEnglish
Pages (from-to)1438-1446
Number of pages9
JournalSurgery (United States)
Volume173
Issue number6
Early online date25 Mar 2023
DOIs
Publication statusPublished - Jun 2023

Bibliographical note

Funding/Support
This research did not receive any specific funding from any
agencies in the public, commercial, or not-for-profit areas.

Publisher Copyright:
© 2023 The Authors

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