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

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.

Figure 1

Textbook outcome of pancreatic surgery (TOPS) categorized based on hospital volume. The textbook outcome of pancreatic surgery is assessed individually and cumulatively. Each factor’s percentage was measured, excluding missing values. The orange line (high-volume center) and blue line (low-volume center) indicate the TOPS success rate, excluding cases that do not meet each TOPS item. The TOPS success rate was higher in high-volume centers than in low-volume centers (62.2% vs. 44.7%, P<0.001). Interestingly there was no significant difference according to hospital volume except for hospital stays over 14 days after operation (76.8% vs. 69.8%, P=0.052). MIPS, minimally invasive pancreatoduodenectomy; POPF, postoperative pancreatic fistula; PPH, postoperative pancreatic hemorrhage.