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2. Are enhanced recovery protocols after pancreatoduodenectomy still efficient when applied in elderly patients? A systematic review and individual patient data meta-analysis

Author

Kuemmerli, C, Balzano, G, Bouwense, S, Braga, M, Coolsen, M, Daniel, S, Dervenis, C, Falconi, M, Hwang, D, Kagedan, D, Kim, S, Lavu, H, Nussbaum, D, Partelli, S, Passeri, M, Pecorelli, N, Pillarisetty, V, Pucci, M, Sutcliffe, R, Tingstedt, B, van der Kolk, M, Vrochides, D, Armstrong, M, Wei, A, Williamsson, C, Yeo, C, Zani, S, Zouros, E, Rozzini, R, Abuhilal, M, Kuemmerli C., Balzano G., Bouwense S. A., Braga M., Coolsen M., Daniel S. K., Dervenis C., Falconi M., Hwang D. W., Kagedan D. J., Kim S. C., Lavu H., Nussbaum D., Partelli S., Passeri M. J., Pecorelli N., Pillarisetty V. G., Pucci M. J., Sutcliffe R. P., Tingstedt B., van der Kolk M., Vrochides D., Armstrong M., Wei A., Williamsson C., Yeo C. J., Zani S., Zouros E., Rozzini R., AbuHilal M., Kuemmerli, C, Balzano, G, Bouwense, S, Braga, M, Coolsen, M, Daniel, S, Dervenis, C, Falconi, M, Hwang, D, Kagedan, D, Kim, S, Lavu, H, Nussbaum, D, Partelli, S, Passeri, M, Pecorelli, N, Pillarisetty, V, Pucci, M, Sutcliffe, R, Tingstedt, B, van der Kolk, M, Vrochides, D, Armstrong, M, Wei, A, Williamsson, C, Yeo, C, Zani, S, Zouros, E, Rozzini, R, Abuhilal, M, Kuemmerli C., Balzano G., Bouwense S. A., Braga M., Coolsen M., Daniel S. K., Dervenis C., Falconi M., Hwang D. W., Kagedan D. J., Kim S. C., Lavu H., Nussbaum D., Partelli S., Passeri M. J., Pecorelli N., Pillarisetty V. G., Pucci M. J., Sutcliffe R. P., Tingstedt B., van der Kolk M., Vrochides D., Armstrong M., Wei A., Williamsson C., Yeo C. J., Zani S., Zouros E., Rozzini R., and AbuHilal M.

Abstract

Background: This meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared to conventional care on postoperative outcomes in patients aged 70 years or older undergoing pancreatoduodenectomy (PD). Methods: Five databases were systematically searched. Comparative studies with available individual patient data (IPD) were included. The main outcomes were postoperative morbidity, length of stay, readmission and postoperative functional recovery elements. To assess an age-dependent effect, the group was divided in septuagenarians (70–79 years) and older patients (≥80 years). Results: IPD were obtained from 15 of 31 eligible studies comprising 1109 patients. The overall complication and major complication rates were comparable in both groups (OR 0.92 [95% CI: 0.65–1.29], p =.596 and OR 1.22 [95% CI: 0.61–2.46], p =.508). Length of hospital stay tended to be shorter in the ERAS group compared to the conventional care group (−0.14 days [95% CI: −0.29 to 0.01], p =.071) while readmission rates were comparable and the total length of stay including days in hospital after readmission tended to be shorter in the ERAS group (−0.28 days [95% CI: −0.62 to 0.05], p =.069). In the subgroups, the length of stay was shorter in octogenarians treated with ERAS (−0.36 days [95% CI: −0.71 to −0.004], p =.048). The readmission rate increased slightly but not significantly while the total length of stay was not longer in the ERAS group. Conclusion: ERAS in the elderly is safe and its benefits are preserved in the care of even in patients older than 80 years. Standardized care protocol should be encouraged in all pancreatic centers.

Published
2024

3. Classification of intraoperative adverse events in visceral surgery

Author

ten Broek, R.B., Rosman, C., Aduse-Poku, M., Aghlamandi, S., Bissett, I., Blanc, C., Brandt, C., Bruppacher, H.R., Bucher, H.C., Clancy, C., Clavien, P.-A., Delrio, P., Espin, E., Engel, A., Gomes, N.V., Galanos-Demiris, K., Gecim, E., Ghaffari, S., Gié, O., Goebel, B., Hahnloser, D., Herbst, F., Ioannidis, O., Joller, S., Kang, Soojin, Kirchhoff, P., Loveday, B., Martín, R., Mayr, J., Meier, S., Murugesan, J., Nally, D., O’Grady, G., Ozcelik, M., Pace, U., Passeri, M., Rabanser, S., Ranter, B., Rega, D., Ridgway, P.F., Schmid, R., Schumacher, P., Solis, A., Steiner, L.A., Villarino, L., Vrochides, D., Gawria, Larsa, Rosenthal, Rachel, van Goor, Harry, and Dell-Kuster, Salome

Published
2022
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5. Impact of enhanced recovery protocols after pancreatoduodenectomy: Meta-Analysis

Author

Kuemmerli, C, Tschuor, C, Kasai, M, Alseidi, A, Balzano, G, Bouwense, S, Braga, M, Coolsen, M, Daniel, S, Dervenis, C, Falconi, M, Hwang, D, Kagedan, D, Kim, S, Lavu, H, Liang, T, Nussbaum, D, Partelli, S, Passeri, M, Pecorelli, N, Pillai, S, Pillarisetty, V, Pucci, M, Su, W, Sutcliffe, R, Tingstedt, B, Van Der Kolk, M, Vrochides, D, Wei, A, Yeo, C, Zani, S, Zouros, E, Abu Hilal, M, Kuemmerli C., Tschuor C., Kasai M., Alseidi A. A., Balzano G., Bouwense S., Braga M., Coolsen M., Daniel S. K., Dervenis C., Falconi M., Hwang D. W., Kagedan D. J., Kim S. C., Lavu H., Liang T., Nussbaum D., Partelli S., Passeri M. J., Pecorelli N., Pillai S. A., Pillarisetty V. G., Pucci M. J., Su W., Sutcliffe R. P., Tingstedt B., Van Der Kolk M., Vrochides D., Wei A., Yeo C. J., Zani S., Zouros E., Abu Hilal M., Kuemmerli, C, Tschuor, C, Kasai, M, Alseidi, A, Balzano, G, Bouwense, S, Braga, M, Coolsen, M, Daniel, S, Dervenis, C, Falconi, M, Hwang, D, Kagedan, D, Kim, S, Lavu, H, Liang, T, Nussbaum, D, Partelli, S, Passeri, M, Pecorelli, N, Pillai, S, Pillarisetty, V, Pucci, M, Su, W, Sutcliffe, R, Tingstedt, B, Van Der Kolk, M, Vrochides, D, Wei, A, Yeo, C, Zani, S, Zouros, E, Abu Hilal, M, Kuemmerli C., Tschuor C., Kasai M., Alseidi A. A., Balzano G., Bouwense S., Braga M., Coolsen M., Daniel S. K., Dervenis C., Falconi M., Hwang D. W., Kagedan D. J., Kim S. C., Lavu H., Liang T., Nussbaum D., Partelli S., Passeri M. J., Pecorelli N., Pillai S. A., Pillarisetty V. G., Pucci M. J., Su W., Sutcliffe R. P., Tingstedt B., Van Der Kolk M., Vrochides D., Wei A., Yeo C. J., Zani S., Zouros E., and Abu Hilal M.

Abstract

Background: This individual-patient data meta-Analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared with conventional care on postoperative outcomes in patients undergoing pancreatoduodenectomy. Methods: The Cochrane Library, MEDLINE, Embase, Scopus, and Web of Science were searched systematically for articles reporting outcomes of ERAS after pancreatoduodenectomy published up to August 2020. Comparative studies were included. Main outcomes were postoperative functional recovery elements, postoperative morbidity, duration of hospital stay, and readmission. Results: Individual-patient data were obtained from 17 of 31 eligible studies comprising 3108 patients. Time to liquid (mean difference (MD)-3.23 (95 per cent c.i.-4.62 to-1.85) days; P < 0.001) and solid (-3.84 (-5.09 to-2.60) days; P < 0.001) intake, time to passage of first stool (MD-1.38 (-1.82 to-0.94) days; P < 0.001) and time to removal of the nasogastric tube (3.03 (-4.87 to-1.18) days; P = 0.001) were reduced with ERAS. ERAS was associated with lower overall morbidity (risk difference (RD)-0.04, 95 per cent c.i.-0.08 to-0.01; P = 0.015), less delayed gastric emptying (RD-0.11,-0.22 to-0.01; P = 0.039) and a shorter duration of hospital stay (MD-2.33 (-2.98 to-1.69) days; P < 0.001) without a higher readmission rate. Conclusion: ERAS improved postoperative outcome after pancreatoduodenectomy. Implementation should be encouraged.

Published
2022

8. Classification of intraoperative adverse events in visceral surgery

Author

Gawria, Larsa, primary, Rosenthal, Rachel, additional, van Goor, Harry, additional, Dell-Kuster, Salome, additional, ten Broek, R.B., additional, Rosman, C., additional, Aduse-Poku, M., additional, Aghlamandi, S., additional, Bissett, I., additional, Blanc, C., additional, Brandt, C., additional, Bruppacher, H.R., additional, Bucher, H.C., additional, Clancy, C., additional, Clavien, P.-A., additional, Delrio, P., additional, Espin, E., additional, Engel, A., additional, Gomes, N.V., additional, Galanos-Demiris, K., additional, Gecim, E., additional, Ghaffari, S., additional, Gié, O., additional, Goebel, B., additional, Hahnloser, D., additional, Herbst, F., additional, Ionnadis, O., additional, Joller, S., additional, Kang, Soojin, additional, Kirchhoff, P., additional, Loveday, B., additional, Martín, R., additional, Mayr, J., additional, Meier, S., additional, Murugesan, J., additional, Nally, D., additional, O’Grady, G., additional, Ozcelik, M., additional, Pace, U., additional, Passeri, M., additional, Rabanser, S., additional, Ranter, B., additional, Rega, D., additional, Ridgway, P.F., additional, Schmid, R., additional, Schumacher, P., additional, Solis, A., additional, Steiner, L.A., additional, Villarino, L., additional, and Vrochides, D., additional

Published
2022
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9. Long-term outcomes of ruptured hepatocellular carcinoma: An international multicentric propensity score-matched study

Author

Joliat, G-R, primary, de Man, R, additional, Rijckborst, V, additional, Cimino, M, additional, Torzilli, G, additional, Choi, G H, additional, Lee, H S, additional, Goh, B, additional, Kokudo, T, additional, Shirata, C, additional, Hasegawa, K, additional, Nishioka, Y, additional, Vauthey, J-N, additional, Baimas-George, M, additional, Vrochides, D, additional, Demartines, N, additional, Halkic, N, additional, and Labgaa, I, additional

Published
2022
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17. Robotic Hepaticojejunostomy

Author

Strand, M., primary, Davis, J., additional, Motz, B., additional, Baker, E., additional, Iannitti, D., additional, Vrochides, D., additional, and Martinie, J., additional

Published
2022
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20. Long-Term Outcomes of Ruptured Hepatocellular Carcinoma: An International Multicentric Propensity Score-Matched Study

Author

Joliat, G.-R., primary, de Man, R., additional, Rijckborst, V., additional, Cimino, M., additional, Torzilli, G., additional, Choi, G.H., additional, Lee, H.S., additional, Goh, B., additional, Kokudo, T., additional, Shirata, C., additional, Hasegawa, K., additional, Nishioka, Y., additional, Vauthey, J.-N., additional, Baimas-George, M., additional, Vrochides, D., additional, Demartines, N., additional, Halkic, N., additional, and Labgaa, I., additional

Published
2022
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23. Robotic Pringle Maneuver

Author

Strand, M., primary, Yoshino, O., additional, Motz, B., additional, Davis, J., additional, Baker, E., additional, Iannitti, D., additional, Martinie, J., additional, and Vrochides, D., additional

Published
2022
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28. Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019

Author

Melloul, E., Lassen, K., Roulin, D., Grass, F., Perinel, J., Adham, M., Wellge, E.B., Kunzler, F., Besselink, M.G., Asbun, H., Scott, M.J., Dejong, CHC, Vrochides, D., Aloia, T., Izbicki, J.R., and Demartines, N.

Subjects
Surgery
Abstract

Enhanced recovery after surgery (ERAS) pathways are now implemented worldwide with strong evidence that adhesion to such protocol reduces medical complications, costs and hospital stay. This concept has been applied for pancreatic surgery since the first published guidelines in 2012. This study presents the updated ERAS recommendations for pancreatoduodenectomy (PD) based on the best available evidence and on expert consensus. A systematic literature search was conducted in three databases (Embase, Medline Ovid and Cochrane Library Wiley) for the 27 developed ERAS items. Quality of randomized trials was assessed using the Consolidated Standards of Reporting Trials statement checklist. The level of evidence for each item was determined using the Grading of Recommendations Assessment Development and Evaluation system. The Delphi method was used to validate the final recommendations. A total of 314 articles were included in the systematic review. Consensus among experts was reached after three rounds. A well-implemented ERAS protocol with good compliance is associated with a reduction in medical complications and length of hospital stay. The highest level of evidence was available for five items: avoiding hypothermia, use of wound catheters as an alternative to epidural analgesia, antimicrobial and thromboprophylaxis protocols and preoperative nutritional interventions for patients with severe weight loss (> 15%). The current updated ERAS recommendations for PD are based on the best available evidence and processed by the Delphi method. Prospective studies of high quality are encouraged to confirm the benefit of current updated recommendations.

Published
2020

30. External validation of three nomograms predicting survival using an international cohort of patients with resected pancreatic head ductal adenocarcinoma

Author

Schneider, M, primary, Labgaa, I, additional, Vrochides, D, additional, Zerbi, A, additional, Nappo, G, additional, Perinel, J, additional, Adham, M, additional, van Roessel, S, additional, Besselink, M, additional, Mieog, J S D, additional, Groen, J V, additional, Demartines, N, additional, Schäfer, M, additional, and Joliat, G -R, additional

Published
2021
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32. External Validation of Three Nomograms Predicting Survival Using an International Cohort of Patients with Resected Pancreatic Head Ductal Adenocarcinoma

Author

Schneider, M., primary, Labgaa, I., additional, Vrochides, D., additional, Zerbi, A., additional, Nappo, G., additional, Perinel, J., additional, Adham, M., additional, van Roessel, S., additional, Besselink, M., additional, Mieog, J.S.D., additional, Groen, J.V., additional, Demartines, N., additional, Schäfer, M., additional, and Joliat, G.-R., additional

Published
2021
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33. Lymph Node Ratio as Predictor of Survival in Patients with Resected Pancreatic Ductal Adenocarcinoma

Author

Joliat, G.-R., primary, Labgaa, I., additional, Sulzer, J., additional, Vrochides, D., additional, Zerbi, A., additional, Nappo, G., additional, Perinel, J., additional, Adham, M., additional, van Roessel, S., additional, Besselink, M., additional, Mieog, J.S.D., additional, Groen, J., additional, Demartines, N., additional, and Schäfer, M., additional

Published
2021
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34. Robotic Transduodenal Ampullectomy

Author

Tschuor, C., primary, Salibi, P.N., additional, Motz, B., additional, Robinson, J., additional, Baker, E., additional, Iannitti, D., additional, Vrochides, D., additional, and Martinie, J.B., additional

Published
2021
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40. The Japanese difficulty scoring system correlates with postoperative outcome assessed by the comprehensive complication index in patients undergoing minimally invasive liver resection

Author

Salibi, P., primary, Watson, M., additional, Tschuor, C., additional, Motz, B., additional, Robinson, J., additional, Loszko, A., additional, Beckman, M., additional, Baker, E., additional, Martinie, J., additional, Iannitti, D., additional, and Vrochides, D., additional

Published
2021
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50. Prospective validation of classification of intraoperative adverse events (ClassIntra): international, multicentre cohort study

Author

Dell-Kuster, S., Gomes, N.V., Gawria, L., Aghlmandi, S., Aduse-Poku, M., Bissett, I., Blanc, C., Brandt, C, Broek, R.B. Ten, Bruppacher, H.R., Clancy, C., Delrio, P., Espin, E., Galanos-Demiris, K., Gecim, I.E., Ghaffari, S., Gié, O., Goebel, B., Hahnloser, D., Herbst, F., Orestis, I., Joller, S., Kang, S., Martín, R., Mayr, J., Meier, S., Murugesan, J., Nally, D., Ozcelik, M., Pace, U., Passeri, M., Rabanser, S., Ranter, B., Rega, D., Ridgway, P.F., Rosman, C., Schmid, R., Schumacher, P., Solis-Pena, A., Villarino, L., Vrochides, D., Engel, A., O'Grady, G., Loveday, B., Steiner, L.A., Goor, H. van, Bucher, H.C., Clavien, P.A., Kirchhoff, P., Rosenthal, R., Dell-Kuster, S., Gomes, N.V., Gawria, L., Aghlmandi, S., Aduse-Poku, M., Bissett, I., Blanc, C., Brandt, C, Broek, R.B. Ten, Bruppacher, H.R., Clancy, C., Delrio, P., Espin, E., Galanos-Demiris, K., Gecim, I.E., Ghaffari, S., Gié, O., Goebel, B., Hahnloser, D., Herbst, F., Orestis, I., Joller, S., Kang, S., Martín, R., Mayr, J., Meier, S., Murugesan, J., Nally, D., Ozcelik, M., Pace, U., Passeri, M., Rabanser, S., Ranter, B., Rega, D., Ridgway, P.F., Rosman, C., Schmid, R., Schumacher, P., Solis-Pena, A., Villarino, L., Vrochides, D., Engel, A., O'Grady, G., Loveday, B., Steiner, L.A., Goor, H. van, Bucher, H.C., Clavien, P.A., Kirchhoff, P., and Rosenthal, R.

Abstract

Contains fulltext : 225914.pdf (Publisher’s version ) (Open Access), OBJECTIVE: To prospectively assess the construct and criterion validity of ClassIntra version 1.0, a newly developed classification for assessing intraoperative adverse events. DESIGN: International, multicentre cohort study. SETTING: 18 secondary and tertiary centres from 12 countries in Europe, Oceania, and North America. PARTICIPANTS: The cohort study included a representative sample of 2520 patients in hospital having any type of surgery, followed up until discharge. A follow-up to assess mortality at 30 days was performed in 2372 patients (94%). A survey was sent to a representative sample of 163 surgeons and anaesthetists from participating centres. MAIN OUTCOME MEASURES: Intraoperative complications were assessed according to ClassIntra. Postoperative complications were assessed daily until discharge from hospital with the Clavien-Dindo classification. The primary endpoint was construct validity by investigating the risk adjusted association between the most severe intraoperative and postoperative complications, measured in a multivariable hierarchical proportional odds model. For criterion validity, inter-rater reliability was evaluated in a survey of 10 fictitious case scenarios describing intraoperative complications. RESULTS: Of 2520 patients enrolled, 610 (24%) experienced at least one intraoperative adverse event and 838 (33%) at least one postoperative complication. Multivariable analysis showed a gradual increase in risk for a more severe postoperative complication with increasing grade of ClassIntra: ClassIntra grade I versus grade 0, odds ratio 0.99 (95% confidence interval 0.69 to 1.42); grade II versus grade 0, 1.39 (0.97 to 2.00); grade III versus grade 0, 2.62 (1.31 to 5.26); and grade IV versus grade 0, 3.81 (1.19 to 12.2). ClassIntra showed high criterion validity with an intraclass correlation coefficient of 0.76 (95% confidence interval 0.59 to 0.91) in the survey (response rate 83%). CONCLUSIONS: ClassIntra is the first prospectively valida

Published
2020

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