Jony van Hilst1,2, Nine de Graaf1,3, Mohammad Abu Hilal3, Marc G Besselink4. 1. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands. 2. Department of Surgery, OLVG, Amsterdam, The Netherlands. 3. Department of Surgery, Instituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy. 4. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands. m.g.besselink@amsterdamumc.nl.
Abstract
BACKGROUND: Pancreatic resections are among the most technically demanding procedures, including a high risk of potentially life-threatening complications and outcomes strongly correlated to hospital volume and individual surgeon experience. Minimally invasive pancreatic resections (MIPRs) have become a part of standard surgical practice worldwide over the last decade; however, in comparison with other surgical procedures, the implementation of minimally invasive approaches into clinical practice has been rather slow. OBJECTIVE: The aim of this study was to highlight and summarize the available randomized controlled trials (RCTs) evaluating the role of minimally invasive approaches in pancreatic surgery. METHODS: A WHO trial registry and Pubmed database literature search was performed to identify all RCTs comparing MIPRs (robot-assisted and/or laparoscopic distal pancreatectomy [DP] or pancreatoduodenectomy [PD]) with open pancreatic resections (OPRs). RESULTS: Overall, five RCTs on MIPR versus OPR have been published and seven RCTs are currently recruiting. For DP, the results of two RCTs were in favor of minimally invasive distal pancreatectomy (MIDP) in terms of shorter hospital stay and less intraoperative blood loss, with comparable morbidity and mortality. Regarding PD, two RCTs showed similar advantages for MIPD. However, concerns were raised after the early termination of the third multicenter RCT on MIPD versus open PD due to higher complication-related mortality in the laparoscopic group and no clear other demonstrable advantages. No RCTs on robot-assisted pancreatic procedures are available as yet. CONCLUSION: At the current level of evidence, MIDP is thought to be safe and feasible, although oncological safety should be further evaluated. Based on the results of the RCTs conducted for PD, MIPD cannot be proclaimed as the superior alternative to open PD, although promising outcomes have been demonstrated by experienced centers. Future studies should provide answers to the role of robotic approaches in pancreatic surgery and aim to identity the subgroups of patients or indications with the greatest benefit of MIPRs.
RCT Entities:
BACKGROUND: Pancreatic resections are among the most technically demanding procedures, including a high risk of potentially life-threatening complications and outcomes strongly correlated to hospital volume and individual surgeon experience. Minimally invasive pancreatic resections (MIPRs) have become a part of standard surgical practice worldwide over the last decade; however, in comparison with other surgical procedures, the implementation of minimally invasive approaches into clinical practice has been rather slow. OBJECTIVE: The aim of this study was to highlight and summarize the available randomized controlled trials (RCTs) evaluating the role of minimally invasive approaches in pancreatic surgery. METHODS: A WHO trial registry and Pubmed database literature search was performed to identify all RCTs comparing MIPRs (robot-assisted and/or laparoscopic distal pancreatectomy [DP] or pancreatoduodenectomy [PD]) with open pancreatic resections (OPRs). RESULTS: Overall, five RCTs on MIPR versus OPR have been published and seven RCTs are currently recruiting. For DP, the results of two RCTs were in favor of minimally invasive distal pancreatectomy (MIDP) in terms of shorter hospital stay and less intraoperative blood loss, with comparable morbidity and mortality. Regarding PD, two RCTs showed similar advantages for MIPD. However, concerns were raised after the early termination of the third multicenter RCT on MIPD versus open PD due to higher complication-related mortality in the laparoscopic group and no clear other demonstrable advantages. No RCTs on robot-assisted pancreatic procedures are available as yet. CONCLUSION: At the current level of evidence, MIDP is thought to be safe and feasible, although oncological safety should be further evaluated. Based on the results of the RCTs conducted for PD, MIPD cannot be proclaimed as the superior alternative to open PD, although promising outcomes have been demonstrated by experienced centers. Future studies should provide answers to the role of robotic approaches in pancreatic surgery and aim to identity the subgroups of patients or indications with the greatest benefit of MIPRs.
Authors: Jony van Hilst; Maarten Korrel; Thijs de Rooij; Sanne Lof; Olivier R Busch; Bas Groot Koerkamp; David A Kooby; Susan van Dieren; Mo Abu Hilal; Marc G Besselink Journal: Eur J Surg Oncol Date: 2018-12-13 Impact factor: 4.424
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: Arianeb Mehrabi; Mohammadreza Hafezi; Jalal Arvin; Majid Esmaeilzadeh; Camelia Garoussi; Golnaz Emami; Julia Kössler-Ebs; Beat Peter Müller-Stich; Markus W Büchler; Thilo Hackert; Markus K Diener Journal: Surgery Date: 2015-01 Impact factor: 3.982
Authors: Jony van Hilst; Thijs de Rooij; Mohammed Abu Hilal; Horacio J Asbun; Jeffrey Barkun; Uggo Boggi; Olivier R Busch; Kevin C P Conlon; Marcel G Dijkgraaf; Ho-Seong Han; Paul D Hansen; Michael L Kendrick; Andre L Montagnini; Chinnusamy Palanivelu; Bård I Røsok; Shailesh V Shrikhande; Go Wakabayashi; Herbert J Zeh; Charles M Vollmer; David A Kooby; Marc G H Besselink Journal: HPB (Oxford) Date: 2017-02-17 Impact factor: 3.647
Authors: Melissa E Hogg; Marc G Besselink; Pierre-Alain Clavien; Abe Fingerhut; D Rohan Jeyarajah; David A Kooby; A James Moser; Henry A Pitt; Oliver A Varban; Charles M Vollmer; Herbert J Zeh; Paul Hansen Journal: HPB (Oxford) Date: 2017-02-10 Impact factor: 3.647
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