Perioperative textbook outcomes of minimally invasive pancreatoduodenectomy: a multicenter retrospective cohort analysis in a Korean minimally invasive pancreatic surgery registry

Jaewoo Kwon; Chang Moo Kang; Jin-Young Jang; Yoo-Seok Yoon; Hyung Jun Kwon; In Seok Choi; Hee Joon Kim; Sang Hyun Shin; Sang Hyun Kang; Hyung Hwan Moon; Dae Wook Hwang; Song Cheol Kim; Korean Study Group on Minimally Invasive Pancreatic Surgery (K-MIPS)

doi:10.1097/JS9.0000000000001390

Perioperative textbook outcomes of minimally invasive pancreatoduodenectomy: a multicenter retrospective cohort analysis in a Korean minimally invasive pancreatic surgery registry

Int J Surg. 2024 Apr 3. doi: 10.1097/JS9.0000000000001390. Online ahead of print.

Affiliations

¹ Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine.
² Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine.
³ Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine.
⁴ Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam.
⁵ Department of Surgery, Kyungpook National University Medical Center, Daegu, Republic of Korea.
⁶ Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon.
⁷ Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Chonnam National University Medical School, Gwangju.
⁸ Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
⁹ Department of Surgery, College of Medicine, Inje University, Busan Paik Hospital.
¹⁰ Department of Surgery, College of Medicine at Kosin University, Busan.
¹¹ Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul.

PMID: 38573082
DOI: 10.1097/JS9.0000000000001390

Abstract

Background: The aim of this study is to investigate the perioperative composite textbook outcomes of pancreatic surgery after minimally invasive pancreatoduodenectomy (MIPD).

Materials and methods: The cohort study was conducted across 10 institutions and included 1552 patients who underwent MIPD registered with the Korean Study Group on Minimally Invasive Pancreatic Surgery between May 2007 and April 2020. We analyzed perioperative textbook outcomes of pancreatic surgery after MIPD. Subgroup analyses were performed to assess outcomes based on the hospital volume of MIPD.

Results: Among all patients, 21.8% underwent robotic pancreatoduodenectomy. High-volume centers (performing >20 MIPD/year) performed 88.1% of the procedures. The incidence of clinically relevant postoperative pancreatic fistula was 11.5%. Severe complications (Clavien-Dindo grade ≥IIIa) occurred in 15.1% of the cases. The 90-day mortality rate was 0.8%. The mean hospital stay was 13.7 days. Textbook outcomes of pancreatic surgery success were achieved in 60.4% of patients, with higher rates observed in high-volume centers than in low-volume centers (62.2% vs. 44.7%, P<0.001). High-volume centers exhibited significantly lower conversion rates (5.4% vs. 12.5%, P=0.001), lower 90-day mortality (0.5% vs. 2.7%, P=0.001), and lower 90-day readmission rates (4.5% vs. 9.6%, P=0.006) than those low-volume centers.

Conclusion: MIPD could be performed safely with permissible perioperative outcomes, including textbook outcomes of pancreatic surgery, particularly in experienced centers. The findings of this study provided valuable insights for guiding surgical treatment decisions in periampullary disease.