Nationwide outcomes of 1000 robotic pancreatoduodenectomies across the four phases of the learning curve

Abstract Background Robotic pancreatoduodenectomy (RPD) is increasingly being implemented to enhance patient recovery, but it is unclear what happens to patient outcomes after the initial learning curve. The aim of this study was to evaluate the first 1000 consecutive RPD performed in the Netherland...

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Veröffentlicht in:British journal of surgery Jg. 112; H. 11
Hauptverfasser: Emmen, Anouk M L H, van den Broek, Bram L J, Hendriks, Tessa E, Busch, Olivier R, Bonsing, Bert A, Cappelle, Marie L, Coene, Peter-Paul L O, Festen, Sebastiaan, van der Harst, Erwin, de Hingh, Ignace H J T, van Laarhoven, Cees J H M, Lips, Daan J, Sprakel, Joost, Luyer, Misha D P, Mieog, J Sven D, van Santvoort, Hjalmar C, van der Schelling, George, Wijsman, Jan H, Patijn, Gijs A, de Wilde, Roeland F, Zwart, Maurice J W, Derksen, Wouter J M, Molenaar, I Quintus, Groot Koerkamp, Bas, Besselink, Marc G
Format: Journal Article
Sprache:Englisch
Veröffentlicht: UK Oxford University Press 06.11.2025
Schlagworte:
Adult
Aged
Aged, 80 and over
Female
Humans
Learning Curve
Length of Stay - statistics & numerical data
Male
Middle Aged
Netherlands - epidemiology
Operative Time
Pancreatic Neoplasms - surgery
Pancreaticoduodenectomy - adverse effects
Pancreaticoduodenectomy - education
Pancreaticoduodenectomy - methods
Pancreaticoduodenectomy - statistics & numerical data
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Retrospective Studies
Robotic Surgical Procedures - adverse effects
Robotic Surgical Procedures - education
Robotic Surgical Procedures - statistics & numerical data
Treatment Outcome
Netherlands
ISSN:0007-1323, 1365-2168, 1365-2168
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Zusammenfassung:Abstract Background Robotic pancreatoduodenectomy (RPD) is increasingly being implemented to enhance patient recovery, but it is unclear what happens to patient outcomes after the initial learning curve. The aim of this study was to evaluate the first 1000 consecutive RPD performed in the Netherlands. Methods A nationwide analysis of patients who underwent RPD in 13 centres (March 2016–August 2023) from the Dutch Pancreatic Cancer Audit was performed. Patients were grouped based on published learning curve cut-offs (phases 1–4): 1–15, 16–62, 63–84, and >84 RPD per centre respectively. Outcomes were compared between the four learning curve phases. Ideal Outcome rates were used to compare outcomes between centres. Results Overall, 1000 patients after RPD were included. The conversion rate was 10.1%, the rate of Clavien–Dindo complications of grade ≥III was 41.3%, the rate of postoperative pancreatic fistula of grade B/C was 24.4%, and the rate of in-hospital/30-day mortality was 3.9%. Of the patients, 71.1% had a high updated alternative fistula risk score. Improvements between the phases were found for five outcomes: median operating time (420, 360, 349, and 369 min respectively; P < 0.001), conversion rate (21.7%, 10.0%, 2.8%, and 7.5% respectively; P < 0.001), rate of delayed gastric emptying (DGE) of grade B/C (32.3%, 22.6%, 15.4%, and 20.2% respectively; P = 0.003), reoperation rate (9.9%, 11.3%, 9.8%, and 4.9% respectively; P = 0.026), and median duration of hospital stay (12, 11, 10, and 10 days respectively; P = 0.035). The rate of Clavien–Dindo complications of grade ≥III and the rate of in-hospital/30-day mortality remained stable. The Ideal Outcome rate (mean 47%) did not differ between centres. Conclusion Across four learning curve phases in a nationwide cohort, improvements were observed for operating time, conversion rate, rate of DGE of grade B/C, reoperation rate, and duration of hospital stay. A nationwide analysis of 1000 patients who underwent robotic pancreatoduodenectomy (RPD) in 13 centres (March 2016–August 2023) was performed. Outcomes were compared between patients in the four learning curve phases (1–15, 16–62, 63–84, and >84 RPD), determined per centre. Improvements were seen for median operative time, conversion rate, delayed gastric emptying grade B/C, reoperation rate, and median hospital stay. Between the four phases, the rate of Clavien–Dindo complications grade ≥III and the rate of in-hospital/30-day mortality remained stable. The nationwide rate of Ideal Outcome rate remained stable.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:0007-1323
1365-2168
1365-2168
DOI:10.1093/bjs/znaf210