Thijs de Rooij1, Anneke P Jilesen1, Djamila Boerma2, Bert A Bonsing3, Koop Bosscha4, Ronald M van Dam5, Susan van Dieren6, Marcel G Dijkgraaf6, Casper H van Eijck7, Michael F Gerhards8, Harry van Goor9, Erwin van der Harst10, Ignace H de Hingh11, Geert Kazemier12, Joost M Klaase13, I Quintus Molenaar14, Els J Nieveen van Dijkum1, Gijs A Patijn15, Hjalmar C van Santvoort1, Joris J Scheepers16, George P van der Schelling17, Egbert Sieders18, Jantien A Vogel1, Olivier R Busch1, Marc G Besselink19. 1. Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands. 2. Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands. 3. Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands. 4. Department of Surgery, Jeroen Bosch Hospital, Den Bosch, the Netherlands. 5. Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands. 6. Clinical Research Unit, Academic Medical Center, Amsterdam, the Netherlands. 7. Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands. 8. Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands. 9. Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands. 10. Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands. 11. Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands. 12. Department of Surgery, VU Medical Center, Amsterdam, the Netherlands. 13. Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands. 14. Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands. 15. Department of Surgery, Isala Clincs, Zwolle, the Netherlands. 16. Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands. 17. Department of Surgery, Amphia Hospital, Breda, the Netherlands. 18. Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands. 19. Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: m.g.besselink@amc.nl.
Abstract
BACKGROUND: Cohort studies from expert centers suggest that laparoscopic distal pancreatectomy (LDP) is superior to open distal pancreatectomy (ODP) regarding postoperative morbidity and length of hospital stay. But the generalizability of these findings is unknown because nationwide data on LDP are lacking. STUDY DESIGN: Adults who had undergone distal pancreatectomy in 17 centers between 2005 and 2013 were analyzed retrospectively. First, all LDPs were compared with all ODPs. Second, groups were matched using a propensity score. Third, the attitudes of pancreatic surgeons toward LDP were surveyed. The primary outcome was major complications (Clavien-Dindo grade ≥III). RESULTS: Among 633 included patients, 64 patients (10%) had undergone LDP and 569 patients (90%) had undergone ODP. Baseline characteristics were comparable, except for previous abdominal surgery and mean tumor size. In the full cohort, LDP was associated with fewer major complications (16% vs 29%; p = 0.02) and a shorter median [interquartile range, IQR] hospital stay (8 days [7-12 days] vs 10 days [8-14 days]; p = 0.03). Of all LDPs, 33% were converted to ODP. Matching succeeded for 63 LDP patients. After matching, the differences in major complications (9 patients [14%] vs 19 patients [30%]; p = 0.06) and median [IQR] length of hospital stay (8 days [7-12 days] vs 10 days [8-14 days]; p = 0.48) were not statistically significant. The survey demonstrated that 85% of surgeons welcomed LDP training. CONCLUSIONS: Despite nationwide underuse and an impact of selection bias, outcomes of LDP seemed to be at least noninferior to ODP. Specific training is welcomed and could improve both the use and outcomes of LDP.
BACKGROUND: Cohort studies from expert centers suggest that laparoscopic distal pancreatectomy (LDP) is superior to open distal pancreatectomy (ODP) regarding postoperative morbidity and length of hospital stay. But the generalizability of these findings is unknown because nationwide data on LDP are lacking. STUDY DESIGN: Adults who had undergone distal pancreatectomy in 17 centers between 2005 and 2013 were analyzed retrospectively. First, all LDPs were compared with all ODPs. Second, groups were matched using a propensity score. Third, the attitudes of pancreatic surgeons toward LDP were surveyed. The primary outcome was major complications (Clavien-Dindo grade ≥III). RESULTS: Among 633 included patients, 64 patients (10%) had undergone LDP and 569 patients (90%) had undergone ODP. Baseline characteristics were comparable, except for previous abdominal surgery and mean tumor size. In the full cohort, LDP was associated with fewer major complications (16% vs 29%; p = 0.02) and a shorter median [interquartile range, IQR] hospital stay (8 days [7-12 days] vs 10 days [8-14 days]; p = 0.03). Of all LDPs, 33% were converted to ODP. Matching succeeded for 63 LDP patients. After matching, the differences in major complications (9 patients [14%] vs 19 patients [30%]; p = 0.06) and median [IQR] length of hospital stay (8 days [7-12 days] vs 10 days [8-14 days]; p = 0.48) were not statistically significant. The survey demonstrated that 85% of surgeons welcomed LDP training. CONCLUSIONS: Despite nationwide underuse and an impact of selection bias, outcomes of LDP seemed to be at least noninferior to ODP. Specific training is welcomed and could improve both the use and outcomes of LDP.
Authors: Thijs de Rooij; Sjors Klompmaker; Mohammad Abu Hilal; Michael L Kendrick; Olivier R Busch; Marc G Besselink Journal: Nat Rev Gastroenterol Hepatol Date: 2016-02-17 Impact factor: 46.802
Authors: Thijs de Rooij; Marc G Besselink; Awad Shamali; Giovanni Butturini; Olivier R Busch; Bjørn Edwin; Roberto Troisi; Laureano Fernández-Cruz; Ibrahim Dagher; Claudio Bassi; Mohammad Abu Hilal Journal: HPB (Oxford) Date: 2015-12-10 Impact factor: 3.647
Authors: Caroline L Lopez; Max B Albers; Carmen Bollmann; Jerena Manoharan; Jens Waldmann; Volker Fendrich; Detlef K Bartsch Journal: World J Surg Date: 2016-07 Impact factor: 3.352