1. Implementation and outcome of minimally invasive pancreatoduodenectomy in Europe:a registry-based retrospective study A critical appraisal of the first 3 years of the E-MIPS registry
- Author
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Emmen, Anouk M L H, de Graaf, Nine, Khatkov, I E, Busch, O R, Dokmak, S, Boggi, Ugo, Groot Koerkamp, Bas, Ferrari, Giovanni, Molenaar, I Q, Saint-Marc, Olivier, Ramera, Marco, Lips, Daan J, Mieog, J S D, Luyer, Misha D P, Keck, Tobias, D'Hondt, Mathieu, Souche, F R, Edwin, Bjørn, Hackert, Thilo, Liem, M S L, Iben-Khayat, Abdallah, van Santvoort, H C, Mazzola, Michele, de Wilde, Roeland F, Kauffmann, E F, Aussilhou, Beatrice, Festen, Sebastiaan, Izrailov, R, Tyutyunnik, P, Besselink, M G, Abu Hilal, Mohammad, Emmen, Anouk M L H, de Graaf, Nine, Khatkov, I E, Busch, O R, Dokmak, S, Boggi, Ugo, Groot Koerkamp, Bas, Ferrari, Giovanni, Molenaar, I Q, Saint-Marc, Olivier, Ramera, Marco, Lips, Daan J, Mieog, J S D, Luyer, Misha D P, Keck, Tobias, D'Hondt, Mathieu, Souche, F R, Edwin, Bjørn, Hackert, Thilo, Liem, M S L, Iben-Khayat, Abdallah, van Santvoort, H C, Mazzola, Michele, de Wilde, Roeland F, Kauffmann, E F, Aussilhou, Beatrice, Festen, Sebastiaan, Izrailov, R, Tyutyunnik, P, Besselink, M G, and Abu Hilal, Mohammad
- Abstract
BACKGROUND: International multicenter audit-based studies focusing on the outcome of minimally invasive pancreatoduodenectomy (MIPD) are lacking. The European Registry for Minimally Invasive Pancreatic Surgery (E-MIPS) is the E-AHPBA endorsed registry aimed to monitor and safeguard the introduction of MIPD in Europe. MATERIALS AND METHODS: A planned analysis of outcomes among consecutive patients after MIPD from 45 centers in 14 European countries in the E-MIPS registry (2019-2021). The main outcomes of interest were major morbidity (Clavien-Dindo grade ≥3) and 30-day/in-hospital mortality. RESULTS: Overall, 1336 patients after MIPD were included [835 robot-assisted (R-MIPD) and 501 laparoscopic MIPD (L-MIPD)]. Overall, 20 centers performed R-MIPD, 15 centers L-MIPD, and 10 centers both. Between 2019 and 2021, the rate of centers performing L-MIPD decreased from 46.9 to 25%, whereas for R-MIPD this increased from 46.9 to 65.6%. Overall, the rate of major morbidity was 41.2%, 30-day/in-hospital mortality 4.5%, conversion rate 9.7%, postoperative pancreatic fistula grade B/C 22.7%, and postpancreatectomy hemorrhage grade B/C 10.8%. Median length of hospital stay was 12 days (IQR 8-21). A lower rate of major morbidity, postoperative pancreatic fistula grade B/C, postpancreatectomy hemorrhage grade B/C, delayed gastric emptying grade B/C, percutaneous drainage, and readmission was found after L-MIPD. The number of centers meeting the Miami Guidelines volume cut-off of ≥20 MIPDs annually increased from 9 (28.1%) in 2019 to 12 (37.5%) in 2021 ( P =0.424). Rates of conversion (7.4 vs. 14.8% P <0.001) and reoperation (8.9 vs. 15.1% P <0.001) were lower in centers, which fulfilled the Miami volume cut-off. CONCLUSION: During the first 3 years of the pan-European E-MIPS registry, morbidity and mortality rates after MIPD were acceptable. A shift is ongoing from L-MIPD to R-MIPD. Variations in outcomes between the two minimally invasive approaches and the impact of the
- Published
- 2024