Setting the Standard in Robotic Whipple Surgery: International Multicenter Benchmark Analysis.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Pfister Matthias, Li Zhihao, Abbassi Fariba, Araujo Raphael L C, Chaudhari Vikram A, Cherif Rim, Foroutani Laleh, Giannone Fabio, Ginesini Michael, Iben-Khayat Abdallah, Lee Boram, Nunez Ricardo, Takishita Chie, Underwood Patrick W, Vigia Emanuel, Vivian Elaina, Watanabe Yusuke, Wakabayashi Taiga, Alseidi Adnan, Di Benedetto Fabrizio, Boggi Ugo, Brustia Raffaele, Cheung Tan-To, Dillhoff Mary E, Goh Brian K P, Han Ho-Seong, Ielpo Benedetto, Lee Jae Hoon, Machado Marcel A, Martinie John, Marques Hugo Pinto, Mejia Alejandro, Nagakawa Yuichi, Nakamura Masafumi, Pessaux Patrick, Polanco Patricio M, Saint-Marc Olivier, Shrikhande Shailesh V, Wakabayashi Go, Clavien Pierre-Alain
Аннотация
SUMMARY BACKGROUND DATA: For safe adoption of surgical innovation, robust quality control is essential. Benchmarking is a validated tool for assessing surgical performance. Recent international consensus identified establishing benchmark values for robotic Whipple as top priority.
METHODS: We analyzed consecutive patients undergoing robotic Whipple between 2020-2023 with a minimum one-year follow-up. Reference centers were required to perform ≥15 cases/year, be scientifically active in the field, and maintain a prospective database. Benchmark criteria included benign or resectable malignant disease without neoadjuvant therapy, arterial resection, major co-morbidities, or significant previous abdominal surgery. Benchmarks were established for 13 outcome parameters.
RESULT: The benchmark cohort comprised 418 patients from 12 centers across four continents. Benchmark values were: conversion rate ≤4.3%, transfusion rate ≤2.1%, 6-month mortality ≤2.2%, major complications ≤23.2%, and CCI® ≤20.9. Clinically relevant pancreatic fistula (grade B/C) and hemorrhage (grade B/C) rates were ≤23.6% and ≤12.7%, respectively. For pancreatic ductal adenocarcinoma (n=123), the benchmark for lymph node yield was ≥20. Higher surgical difficulty was associated with increased overall postoperative morbidity (R2=0.38, P=0.019), higher center caseload with reduced pancreas-specific complications (R2=0.28, P=0.044). Independent POPF predictors included duct diameter ≤4 mm (OR 1.37, 95% CI: 1.03, 1.82), anticoagulation (OR 2.45, 95% CI: 1.47, 3.99), and indication other than PDAC (OR 2.33, 95% CI: 1.68, 3.27).
CONCLUSIONS: This study establishes the first international benchmarks for robotic Whipple, demonstrating oncologic outcomes and morbidity comparable to open surgery with the benefits of minimally invasive surgery.