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. 2023 Sep;75(6):1439-1456.
doi: 10.1007/s13304-023-01592-7. Epub 2023 Jul 20.

Prospective minimally invasive pancreatic resections from the IGOMIPS registry: a snapshot of daily practice in Italy on 1191 between 2019 and 2022

Ugo Boggi  1 , Greta Donisi  2   3 , Niccolò Napoli  4 , Stefano Partelli  5   6 , Alessandro Esposito  7 , Giovanni Ferrari  8 , Giovanni Butturini  9 , Luca Morelli  10   11 , Mohammad Abu Hilal  12 , Massimo Viola  13 , Fabrizio Di Benedetto  14 , Roberto Troisi  15 , Marco Vivarelli  16 , Elio Jovine  17 , Alessandro Ferrero  18 , Umberto Bracale  19 , Sergio Alfieri  20 , Riccardo Casadei  21 , Giorgio Ercolani  22 , Luca Moraldi  23 , Carlo Molino  24 , Raffaele Dalla Valle  25 , Giuseppe Ettorre  26 , Riccardo Memeo  27 , Giacomo Zanus  28 , Andrea Belli  29 , Salvatore Gruttadauria  30 , Alberto Brolese  31 , Andrea Coratti  32 , Gianluca Garulli  33 , Renato Romagnoli  34 , Marco Massani  35 , Felice Borghi  36 , Giulio Belli  37 , Roberto Coppola  38 , Massimo Falconi  5 , Roberto Salvia  7 , Alessandro Zerbi  2 ; IGOMPIS registry
Collaborators, Affiliations

Prospective minimally invasive pancreatic resections from the IGOMIPS registry: a snapshot of daily practice in Italy on 1191 between 2019 and 2022

Ugo Boggi et al. Updates Surg. 2023 Sep.

Erratum in

Abstract

This retrospective analysis of the prospective IGOMIPS registry reports on 1191 minimally invasive pancreatic resections (MIPR) performed in Italy between 2019 and 2022, including 668 distal pancreatectomies (DP) (55.7%), 435 pancreatoduodenectomies (PD) (36.3%), 44 total pancreatectomies (3.7%), 36 tumor enucleations (3.0%), and 8 central pancreatectomies (0.7%). Spleen-preserving DP was performed in 109 patients (16.3%). Overall incidence of severe complications (Clavien-Dindo ≥ 3) was 17.6% with a 90-day mortality of 1.9%. This registry analysis provided some important information. First, robotic assistance was preferred for all MIPR but DP with splenectomy. Second, robotic assistance reduced conversion to open surgery and blood loss in comparison to laparoscopy. Robotic PD was also associated with lower incidence of severe postoperative complications and a trend toward lower mortality. Fourth, the annual cut-off of ≥ 20 MIPR and ≥ 20 MIPD improved selected outcome measures. Fifth, most MIPR were performed by a single surgeon. Sixth, only two-thirds of the centers performed spleen-preserving DP. Seventh, DP with splenectomy was associated with higher conversion rate when compared to spleen-preserving DP. Eighth, the use of pancreatojejunostomy was the prevalent reconstruction in PD. Ninth, final histology was similar for MIPR performed at high- and low-volume centers, but neoadjuvant chemotherapy was used more frequently at high-volume centers. Finally, this registry analysis raises important concerns about the reliability of R1 assessment underscoring the importance of standardized pathology of pancreatic specimens. In conclusion, MIPR can be safely implemented on a national scale. Further analyses are required to understand nuances of implementation of MIPR in Italy.

Keywords: Minimally invasive central pancreatectomy; Minimally invasive distal pancreatectomy; Minimally invasive pancreatic resection; Minimally invasive pancreatoduodenectomy; Minimally invasive total pancreatectomy; Registry; Spleen-preserving minimally invasive distal pancreatectomy.

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Conflict of interest statement

There are no conflict of interest or competing interests to declare. The authors declare they have no conflict of interest. The IGOMPIS registry was preregistered in the Registry of Patient Registries (RoPR) of the Agency for Healthcare and Research and Quality, US Department of Health (Registry of Patient Registries. Content last reviewed April 2019 https://www.ahrq.gov/ropr/index.html).

Figures

Fig. 1
Fig. 1
Number of cases reported (within columns) by trimester and number of active centers (above columns)
Fig. 2
Fig. 2
Study flowchart
Fig. 3
Fig. 3
Proportion of DPWS and SPDP at high- and low-volume centers
Fig. 4
Fig. 4
Distribution of tumor types at high- and low-volume centers. The seemingly higher proportion of malignant histology at low-volume centers (however, not reaching statistical significance) is explained by the higher proportion of SPDP at high-volume centers. pNET pancreatic neuroendocrine tumor
See this image and copyright information in PMC

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