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Article ; Online: Early experience with robotic pancreatoduodenectomy versus open pancreatoduodenectomy: nationwide propensity-score-matched analysis.

de Graaf, Nine / Zwart, Maurice J W / van Hilst, Jony / van den Broek, Bram / Bonsing, Bert A / Busch, Olivier R / Coene, Peter-Paul L O / Daams, Freek / van Dieren, Susan / van Eijck, Casper H J / Festen, Sebastiaan / de Hingh, Ignace H J T / Lips, Daan J / Luyer, Misha D P / Mieog, J Sven D / van Santvoort, Hjalmar C / van der Schelling, George P / Stommel, Martijn W J / de Wilde, Roeland F /

Molenaar, I Quintus / Groot Koerkamp, Bas / Besselink, Marc G

The British journal of surgery

2024 Volume 111, Issue 2

Abstract: ... 4.0% versus 3.1% respectively; P = 0.326), and postoperative pancreatic fistula grade B/C (24.9 ...

Abstract	Background: Although robotic pancreatoduodenectomy has shown promising outcomes in experienced high-volume centres, it is unclear whether implementation on a nationwide scale is safe and beneficial. The aim of this study was to compare the outcomes of the early experience with robotic pancreatoduodenectomy versus open pancreatoduodenectomy in the Netherlands. Methods: This was a nationwide retrospective cohort study of all consecutive patients who underwent robotic pancreatoduodenectomy or open pancreatoduodenectomy who were registered in the mandatory Dutch Pancreatic Cancer Audit (18 centres, 2014-2021), starting from the first robotic pancreatoduodenectomy procedure per centre. The main endpoints were major complications (Clavien-Dindo grade greater than or equal to III) and in-hospital/30-day mortality. Propensity-score matching (1 : 1) was used to minimize selection bias. Results: Overall, 701 patients who underwent robotic pancreatoduodenectomy and 4447 patients who underwent open pancreatoduodenectomy were included. Among the eight centres that performed robotic pancreatoduodenectomy, the median robotic pancreatoduodenectomy experience was 86 (range 48-149), with a 7.3% conversion rate. After matching (698 robotic pancreatoduodenectomy patients versus 698 open pancreatoduodenectomy control patients), no significant differences were found in major complications (40.3% versus 36.2% respectively; P = 0.186), in-hospital/30-day mortality (4.0% versus 3.1% respectively; P = 0.326), and postoperative pancreatic fistula grade B/C (24.9% versus 23.5% respectively; P = 0.578). Robotic pancreatoduodenectomy was associated with a longer operating time (359 min versus 301 min; P < 0.001), less intraoperative blood loss (200 ml versus 500 ml; P < 0.001), fewer wound infections (7.4% versus 12.2%; P = 0.008), and a shorter hospital stay (11 days versus 12 days; P < 0.001). Centres performing greater than or equal to 20 robotic pancreatoduodenectomies annually had a lower mortality rate (2.9% versus 7.3%; P = 0.009) and a lower conversion rate (6.3% versus 11.2%; P = 0.032). Conclusion: This study indicates that robotic pancreatoduodenectomy was safely implemented nationwide, without significant differences in major morbidity and mortality compared with matched open pancreatoduodenectomy patients. Randomized trials should be carried out to verify these findings and confirm the observed benefits of robotic pancreatoduodenectomy versus open pancreatoduodenectomy.
MeSH term(s)	Humans ; Pancreaticoduodenectomy/adverse effects ; Retrospective Studies ; Robotic Surgical Procedures/adverse effects ; Pancreas ; Blood Loss, Surgical ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology
Language	English
Publishing date	2024-02-28
Publishing country	England
Document type	Journal Article
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1093/bjs/znae043
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Article ; Online: Recent insights into the pathogenesis of type AA amyloidosis.

van der Hilst, J C H

TheScientificWorldJournal

2011 Volume 11, Page(s) 641–650

Abstract: ... into an amyloid fibril, two processes have to occur: C-terminal cleavage and conversion into a beta-sheet. Only ...

Abstract	The amyloidoses are a group of life-threatening diseases in which fibrils made of misfolded proteins are deposited in organs and tissues. The fibrils are stable, insoluble aggregates of precursor proteins that have adopted an antiparallel beta-sheet structure. In type AA, or reactive, amyloidosis, the precursor protein of the fibrils is serum amyloid A (SAA). SAA is a 104-amino-acid protein that is produced in the liver in response to proinflammatory cytokines. Although the protein that is produced by the liver contains 104 amino acids, only the N-terminal 66-76 amino acids are found in amyloid fibrils. Furthermore, SAA has been shown to have an alpha-helical structure primarily. Thus, for SAA to be incorporated into an amyloid fibril, two processes have to occur: C-terminal cleavage and conversion into a beta-sheet. Only a minority of patients with elevated SAA levels develop amyloidosis. Factors that contribute to the risk of amyloidosis include the duration and degree of SAA elevation, polymorphisms in SAA, and the type of autoinflammatory syndrome. In the Hyper-IgD syndrome, amyloidosis is less prevalent than in the other autoinflammatory diseases. In vitro work has shown that the isoprenoid pathway influences amyloidogenesis by farnesylated proteins. Although many proteins contain domains that have a potential for self-aggregation, amyloidosis is only a very rare event. Heat shock proteins (HSPs) are chaperones that assist other proteins to attain, maintain, and regain a functional conformation. In this review, recent insights into the pathogenesis of amyloidosis are discussed, in addition to a new hypothesis for a role of HSPs in the pathogenesis of type AA.
MeSH term(s)	Amyloidosis/etiology ; Amyloidosis/metabolism ; Amyloidosis/pathology ; Cathepsin D/metabolism ; Heat-Shock Proteins/physiology ; Humans ; Molecular Chaperones/physiology ; Protein Conformation ; Risk Factors ; Serum Amyloid A Protein/chemistry ; Serum Amyloid A Protein/genetics ; Serum Amyloid A Protein/metabolism
Chemical Substances	Heat-Shock Proteins ; Molecular Chaperones ; Serum Amyloid A Protein ; Cathepsin D (EC 3.4.23.5)
Language	English
Publishing date	2011-03-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2075968-X
ISSN	1537-744X ; 1537-744X
ISSN (online)	1537-744X
ISSN	1537-744X
DOI	10.1100/tsw.2011.64
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Article ; Online: Nationwide use and Outcome of Minimally Invasive Distal Pancreatectomy in IDEAL Stage IV following a Training Program and Randomized Trial.

Annals of surgery

2023 Volume 279, Issue 2, Page(s) 323–330

Abstract: ... less blood loss (median 150 vs. 500 mL, P <0.001), but more grade B/C postoperative pancreatic fistula ...

Abstract	Objective: To assess the nationwide long-term uptake and outcomes of minimally invasive distal pancreatectomy (MIDP) after a nationwide training program and randomized trial. Background: Two randomized trials demonstrated the superiority of MIDP over open distal pancreatectomy (ODP) in terms of functional recovery and hospital stay. Data on implementation of MIDP on a nationwide level are lacking. Methods: Nationwide audit-based study including consecutive patients after MIDP and ODP in 16 centers in the Dutch Pancreatic Cancer Audit (2014 to 2021). The cohort was divided into three periods: early implementation, during the LEOPARD randomized trial, and late implementation. Primary endpoints were MIDP implementation rate and textbook outcome. Results: Overall, 1496 patients were included with 848 MIDP (56.5%) and 648 ODP (43.5%). From the early to the late implementation period, the use of MIDP increased from 48.6% to 63.0% and of robotic MIDP from 5.5% to 29.7% ( P <0.001). The overall use of MIDP (45% to 75%) and robotic MIDP (1% to 84%) varied widely between centers ( P <0.001). In the late implementation period, 5/16 centers performed >75% of procedures as MIDP. After MIDP, in-hospital mortality and textbook outcome remained stable over time. In the late implementation period, ODP was more often performed in ASA score III-IV (24.9% vs. 35.7%, P =0.001), pancreatic cancer (24.2% vs. 45.9%, P <0.001), vascular involvement (4.6% vs. 21.9%, P <0.001), and multivisceral involvement (10.5% vs. 25.3%, P <0.001). After MIDP, shorter hospital stay (median 7 vs. 8 d, P <0.001) and less blood loss (median 150 vs. 500 mL, P <0.001), but more grade B/C postoperative pancreatic fistula (24.4% vs. 17.2%, P =0.008) occurred as compared to ODP. Conclusion: A sustained nationwide implementation of MIDP after a successful training program and randomized trial was obtained with satisfactory outcomes. Future studies should assess the considerable variation in the use of MIDP between centers and, especially, robotic MIDP.
MeSH term(s)	Humans ; Pancreatectomy/methods ; Robotic Surgical Procedures/methods ; Treatment Outcome ; Laparoscopy/methods ; Pancreatic Neoplasms/surgery ; Postoperative Complications/etiology ; Length of Stay ; Retrospective Studies
Language	English
Publishing date	2023-05-04
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000005900
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Article ; Online: Prevalence of drug-drug interactions in the era of HIV integrase inhibitors: a retrospective clinical study.

Baecke, C / Gyssens, I C / Decoutere, L / van der Hilst, J C H / Messiaen, P

The Netherlands journal of medicine

2017 Volume 75, Issue 6, Page(s) 235–240

Abstract: Background: Antiretroviral agents pose a high risk for drug-drug interactions (DDIs), mainly but not limited to being a substrate, inducer or inhibitor of P450 cytochrome enzymes. In part metabolised by other pathways, integrase inhibitors might show a ... ...

Abstract	Background: Antiretroviral agents pose a high risk for drug-drug interactions (DDIs), mainly but not limited to being a substrate, inducer or inhibitor of P450 cytochrome enzymes. In part metabolised by other pathways, integrase inhibitors might show a more favourable profile. The aim of this study was to investigate the prevalence of DDIs in daily clinical practice for patients starting different antiretroviral treatment (ART) regimens. Methods: All patients starting ART in our centre from January 2009 to April 2016 were included. All prescribed co-medications since the start of ART were recorded retrospectively from the medical files and screened for DDIs using the Liverpool HIV drug interaction database. Only DDIs between antiretroviral and non-antiretroviral drugs were considered. Results: We included 145 patients, of which 42% were on an integrase inhibitor-based regimen, mainly dolutegravir and elvitegravir. Of the patients, 78% (n = 113) took co-medication. Potential DDIs were seen in 63% of the patients with co-medication; contraindicated prescriptions were detected in 1%. Protease inhibitor-based ART was a risk factor for DDI (odds ratio (OR) 2.57; 95% confidence interval (CI) 1.06-6.19), in contrast to non-nucleoside reverse transcriptase inhibitor-based ART (OR 0.77; 95% CI 0.32-1.84). Concerning integrase inhibitors, a significantly lower risk was seen with dolutegravir-based treatment (OR 0.35; 95% CI 0.15-0.82), though not for elvitegravir-based ART (OR 2.51; 95% CI 0.66-9.58). Conclusions: ART regimens pose a dissimilar risk for drug-drug interactions in clinical practice. Regarding the use of integrase inhibitors, a significantly lower risk was seen with dolutegravir-based treatment.
MeSH term(s)	Adult ; Anti-Retroviral Agents/adverse effects ; Databases, Factual ; Drug Interactions ; Drug-Related Side Effects and Adverse Reactions/epidemiology ; Female ; HIV Infections/drug therapy ; HIV Integrase Inhibitors/adverse effects ; Heterocyclic Compounds, 3-Ring/adverse effects ; Humans ; Male ; Middle Aged ; Oxazines ; Piperazines ; Prevalence ; Pyridones ; Quinolones/adverse effects ; Retrospective Studies ; Risk Factors
Chemical Substances	Anti-Retroviral Agents ; HIV Integrase Inhibitors ; Heterocyclic Compounds, 3-Ring ; Oxazines ; Piperazines ; Pyridones ; Quinolones ; elvitegravir (4GDQ854U53) ; dolutegravir (DKO1W9H7M1)
Language	English
Publishing date	2017-07-09
Publishing country	Netherlands
Document type	Clinical Study ; Journal Article
ZDB-ID	193149-0
ISSN	1872-9061 ; 0300-2977
ISSN (online)	1872-9061
ISSN	0300-2977
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Article ; Online: Impact of extent of disease on 1-year healthcare costs in patients who undergo cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: retrospective observational cohort study.

Kooijman, B J L / Hentzen, J E K R / van der Hilst, C S / Been, L B / van Ginkel, R J / Hemmer, P H J / Klaase, J M / Kruijff, S

BJS open

2020 Volume 4, Issue 5, Page(s) 954–962

Abstract: Background: The goal of this retrospective observational study was to determine the impact of the extent of peritoneal disease on 1-year healthcare costs in patients with colorectal peritoneal metastases (PM) who undergo cytoreductive surgery with ... ...

Abstract	Background: The goal of this retrospective observational study was to determine the impact of the extent of peritoneal disease on 1-year healthcare costs in patients with colorectal peritoneal metastases (PM) who undergo cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC). The extent of peritoneal disease, expressed by the Peritoneal Cancer Index (PCI), directly affects the complexity of CRS + HIPEC and ultimately survival outcomes. The impact of the PCI on treatment-related healthcare costs remains unknown. Methods: Data from patients with colorectal PM who underwent CRS + HIPEC between January 2012 and November 2017 were extracted retrospectively from an institutional database. Patients were divided into four subgroups with PCI scores ranging from 0 to 20. Treatment-related costs up to 1 year after CRS + HIPEC were obtained from the financial department. Differences in costs and survival outcomes were compared using the χ Results: Seventy-three patients were included (PCI 0-5, 22 patients; PCI 6-10, 19 patients; PCI 11-15, 17 patients; PCI 16-20, 15 patients). Median (i.q.r.) costs were significantly increased for the PCI 11-15 and PCI 16-20 groups (€51 029 (42 500-58 575) and €46 548 (35 194-60 533) respectively) compared with those for the PCI 0-5 and PCI 6-10 groups (€33 856 (25 293-42 235) and €39 013 (30 519-51 334) respectively) (P = 0·009). Conclusion: Treatment-related healthcare costs are significantly increased among patients with extensive tumour burden (PCI score 10 or above) who undergo CRS + HIPEC for the treatment of colorectal PM.
MeSH term(s)	Aged ; Chemotherapy, Cancer, Regional Perfusion/economics ; Colorectal Neoplasms/pathology ; Combined Modality Therapy/economics ; Female ; Health Care Costs ; Humans ; Hyperthermia, Induced ; Hyperthermic Intraperitoneal Chemotherapy/economics ; Male ; Middle Aged ; Netherlands ; Peritoneal Neoplasms/economics ; Peritoneal Neoplasms/secondary ; Peritoneal Neoplasms/therapy ; Retrospective Studies ; Tumor Burden
Language	English
Publishing date	2020-07-11
Publishing country	England
Document type	Journal Article ; Observational Study
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1002/bjs5.50320
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Article ; Online: Does the meld system provide equal access to liver transplantation for patients with different ABO blood groups?

IJtsma, Alexander J C / van der Hilst, Christian S / Nijkamp, Danielle M / Bottema, Jan T / Fidler, Vaclav / Porte, Robert J / Slooff, Maarten J H

Transplant international : official journal of the European Society for Organ Transplantation

2016 Volume 29, Issue 8, Page(s) 883–889

Abstract: This study investigates the relationship between blood group and waiting time until transplantation or death on the waiting list. All patients listed for liver transplantation in the Netherlands between 15 December 2006 and 31 December 2012, were ... ...

Abstract	This study investigates the relationship between blood group and waiting time until transplantation or death on the waiting list. All patients listed for liver transplantation in the Netherlands between 15 December 2006 and 31 December 2012, were included. Study variables were gender, age, year of listing, diagnosis, previous transplantations, blood group, urgency, and MELD score. Using a competing risks analysis, separate cumulative incidence curves were constructed for death on the waiting list and transplantation and used to evaluate outcomes.In 517 listings, the mean death rate per 100 patient-years was 10.4. A total of 375 (72.5% of all listings) were transplanted. Of all transplantations, 352 (93.9%) were ABO-identical and 23 (6.1%) ABO-compatible. The 5-year cumulative incidence of death was 11.2% (SE 1.4%), and of transplantation 72.5% (SE 2.0%). Patient blood group had no multivariate significant impact on the hazard of dying on the waiting list nor on transplantation. Age, MELD score, and urgency status were significantly related to the death on the waiting list and transplantation. More recent listing had higher probability of being transplanted. In the MELD era, patient blood group status does not have a significant impact on liver transplant waiting list mortality nor on waiting time for transplantation.
MeSH term(s)	ABO Blood-Group System ; Adolescent ; Adult ; Algorithms ; Child ; Female ; Health Services Accessibility ; Humans ; Liver/surgery ; Liver Failure/mortality ; Liver Failure/surgery ; Liver Transplantation/methods ; Liver Transplantation/mortality ; Male ; Middle Aged ; Multivariate Analysis ; Netherlands ; Probability ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Time Factors ; Waiting Lists
Chemical Substances	ABO Blood-Group System
Language	English
Publishing date	2016-08
Publishing country	England
Document type	Journal Article
ZDB-ID	639435-8
ISSN	1432-2277 ; 0934-0874
ISSN (online)	1432-2277
ISSN	0934-0874
DOI	10.1111/tri.12774
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Article ; Online: A 47-year-old woman with fever and periorbital oedema. Trichinellosis.

Messiaen, P E A / Peeters, K / van Esbroeck, M J A / Bijnens, E J L / Wouters, K K / Gyssens, I C / van der Hilst, J C H

The Netherlands journal of medicine

2016 Volume 74, Issue 2, Page(s) 96–97

MeSH term(s)	Animals ; Diagnosis, Differential ; Edema/complications ; Edema/diagnosis ; Edema/parasitology ; Female ; Fever/diagnosis ; Fever/etiology ; Humans ; Middle Aged ; Orbital Diseases/complications ; Orbital Diseases/diagnosis ; Orbital Diseases/parasitology ; Trichinella/isolation & purification ; Trichinellosis/complications ; Trichinellosis/diagnosis ; Trichinellosis/parasitology
Language	English
Publishing date	2016-02
Publishing country	Netherlands
Document type	Case Reports ; Journal Article
ZDB-ID	193149-0
ISSN	1872-9061 ; 0300-2977
ISSN (online)	1872-9061
ISSN	0300-2977
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Article: Carbon balance and economic performance of pine plantations for bioenergy production in the Southeastern United States

Jonker, J.G.G / van der Hilst, F / Markewitz, D / Faaij, A.P.C / Junginger, H.M

Elsevier Ltd Biomass and bioenergy. 2018 Oct., v. 117

2018

Abstract: Management strategies for loblolly pine (Pinus taeda) plantations in the Southeastern USA can be adapted to fulfill both the demand for wood products and for bioenergy. This study quantifies the impact of plantation management choices on the cumulative ... ...

Abstract	Management strategies for loblolly pine (Pinus taeda) plantations in the Southeastern USA can be adapted to fulfill both the demand for wood products and for bioenergy. This study quantifies the impact of plantation management choices on the cumulative carbon balance and the net present value of loblolly pine plantations at the stand level, as well as the wood supply cost for bioenergy production for these different management strategies. The strategies assessed (conventional, additional thinning and short rotation) are characterised by planting density, thinning age and rotation period, each with and without collection and utilization of slash residues for bioenergy. The total wood supply costs for bioenergy include the cultivation, harvesting and transport costs for small diameter trees and slash. The results show that the carbon balance after 100 years is 205 (247), 214 (268) and 149 (195) Mg ha−1 for the conventional, additional thinning, and short rotation loblolly pine plantation management strategies (within parentheses: same strategies with slash utilization). The conventional strategy has the lowest wood supply costs for bioenergy, 47 (46) $ Mg−1 pulpwood, followed by the additional thinning strategy, 50 (49) $ Mg−1 pulpwood, and 54 (52) $ Mg−1 pulpwood for the short rotation management strategy. In conclusion, switching from the current conventional strategy without the utilization of slash for bioenergy to an additional thinning strategy with the use of slash increases the overall carbon accumulation by about 31%, at marginally higher wood supply cost. Adapting plantation management strategies can have a positive effect on the economic performance and on the carbon balance of loblolly pine plantations. Integration of wood supply for bioenergy and traditional forestry sectors can lead to co-benefits in terms of cost reduction and carbon accumulation.
Keywords	Pinus taeda ; bioenergy ; carbon ; cost effectiveness ; economic performance ; forestry ; harvesting ; plant density ; plantations ; pulpwood ; slash ; Southeastern United States
Language	English
Dates of publication	2018-10
Size	p. 44-55.
Publishing place	Elsevier Ltd
Document type	Article
ZDB-ID	1090121-8
ISSN	0961-9534
ISSN	0961-9534
DOI	10.1016/j.biombioe.2018.06.017
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Article ; Online: Recent Insights into the Pathogenesis of Type AA Amyloidosis

J. C. H. van der Hilst

The Scientific World Journal, Vol 11, Pp 641-

2011 Volume 650

Abstract: ... into an amyloid fibril, two processes have to occur: C-terminal cleavage and conversion into a β-sheet. Only a minority ...

Abstract	The amyloidoses are a group of life-threatening diseases in which fibrils made of misfolded proteins are deposited in organs and tissues. The fibrils are stable, insoluble aggregates of precursor proteins that have adopted an antiparallel β-sheet structure. In type AA, or reactive, amyloidosis, the precursor protein of the fibrils is serum amyloid A (SAA). SAA is a 104-amino-acid protein that is produced in the liver in response to proinflammatory cytokines. Although the protein that is produced by the liver contains 104 amino acids, only the N-terminal 66–76 amino acids are found in amyloid fibrils. Furthermore, SAA has been shown to have an α-helical structure primarily. Thus, for SAA to be incorporated into an amyloid fibril, two processes have to occur: C-terminal cleavage and conversion into a β-sheet. Only a minority of patients with elevated SAA levels develop amyloidosis. Factors that contribute to the risk of amyloidosis include the duration and degree of SAA elevation, polymorphisms in SAA, and the type of autoinflammatory syndrome. In the Hyper-IgD syndrome, amyloidosis is less prevalent than in the other autoinflammatory diseases. In vitro work has shown that the isoprenoid pathway influences amyloidogenesis by farnesylated proteins. Although many proteins contain domains that have a potential for self-aggregation, amyloidosis is only a very rare event. Heat shock proteins (HSPs) are chaperones that assist other proteins to attain, maintain, and regain a functional conformation. In this review, recent insights into the pathogenesis of amyloidosis are discussed, in addition to a new hypothesis for a role of HSPs in the pathogenesis of type AA.
Keywords	Technology ; T ; Medicine ; R ; Science ; Q
Subject code	612
Language	English
Publishing date	2011-01-01T00:00:00Z
Publisher	Hindawi Limited
Document type	Article ; Online
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Article ; Online: Outcomes of a Multicenter Training Program in Robotic Pancreatoduodenectomy (LAELAPS-3).

Zwart, Maurice J W / Nota, Carolijn L M / de Rooij, Thijs / van Hilst, Jony / Te Riele, Wouter W / van Santvoort, Hjalmar C / Hagendoorn, Jeroen / Borei Rinkes, Inne H M / van Dam, Jacob L / Latenstein, Anouk E J / Takagi, Kosei / Tran, Khé T C / Schreinemakers, Jennifer / van der Schelling, George P / Wijsman, Jan H / Festen, Sebastiaan / Daams, Freek / Luyer, Misha D / de Hingh, Ignace H J T /

Mieog, Jan S D / Bonsing, Bert A / Lips, Daan J / Hilal, Mohammed Abu / Busch, Olivier R / Saint-Marc, Olivier / Zehl, Herbert J / Zureikat, Amer H / Hogg, Melissa E / Molenaar, I Quintus / Besselink, Marc G / Koerkamp, Bas Groot

Annals of surgery

2021 Volume 276, Issue 6, Page(s) e886–e895

Abstract: ... was 44.4% (n = 122), postoperative pancreatic fistula (grade B/C) rate 23.6% (n = 65), 90-day ...

Abstract	Objective: To assess feasibility and safety of a multicenter training program in robotic pancreatoduodenectomy (RPD) adhering to the IDEAL framework for implementation of surgical innovation. Background: Good results for RPD have been reported from single center studies. However, data on feasibility and safety of implementation through a multicenter training program in RPD are lacking. Methods: A multicenter training program in RPD was designed together with the University of Pittsburgh Medical Center, including an online video bank, robot simulation exercises, biotissue drills, and on-site proctoring. Benchmark patients were based on the criteria of Clavien. Outcomes were collected prospectively (March 2016-October 2019). Cumulative sum analysis of operative time was performed to distinguish the first and second phase of the learning curve. Outcomes were compared between both phases of the learning curve. Trends in nationwide use of robotic and laparoscopic PD were assessed in the Dutch Pancreatic Cancer Audit. Results: Overall, 275 RPD procedures were performed in seven centers by 15 trained surgeons. The recent benchmark criteria for low-risk PD were met by 125 (45.5%) patients. The conversion rate was 6.5% (n = 18) and median blood loss 250ml [interquartile range (IQR) 150-500]. The rate of Clavien-Dindo grade ≥III complications was 44.4% (n = 122), postoperative pancreatic fistula (grade B/C) rate 23.6% (n = 65), 90-day complication-related mortality 2.5% (n = 7) and 90-day cancer-related mortality 2.2.% (n = 6). Median postoperative hospital stay was 12 days (IQR 8-20). In the subgroup of patients with pancreatic cancer (n = 80), the major complication rate was 31.3% and POPF rate was 10%. Cumulative sum analysis for operative time found a learning curve inflection point at 22 RPDs (IQR 10-35) with similar rates of Clavien-Dindo grade ≥III complications in the first and second phase (43.4% vs 43.8%, P = 0.956, respectively). During the study period the nationwide use of laparoscopic PD reduced from 15% to 1%, whereas the use of RPD increased from 0% to 25%. Conclusions: This multicenter RPD training program in centers with sufficient surgical volume was found to be feasible without a negative impact of the learning curve on clinical outcomes.
MeSH term(s)	Humans ; Pancreaticoduodenectomy/methods ; Robotics ; Robotic Surgical Procedures/methods ; Pancreatic Fistula/etiology ; Laparoscopy/methods ; Pancreatic Neoplasms/surgery ; Pancreatic Neoplasms/complications ; Postoperative Complications/etiology ; Retrospective Studies ; Pancreatic Neoplasms
Language	English
Publishing date	2021-02-01
Publishing country	United States
Document type	Multicenter Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000004783
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