The PD-ROBOSCORE: a difficulty score for robotic pancreatoduodenectomy
Background - Difficulty scoring systems are important for the safe, stepwise implementation of new procedures. We designed a retrospective observational study for building a difficulty score for robotic pancreatoduodenectomy. - Methods - The difficulty score (PD-ROBOSCORE) aims at predicting severe...
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| Hauptverfasser: | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
June 2023
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| In: |
Surgery
Year: 2023, Jahrgang: 173, Heft: 6, Pages: 1438-1446 |
| ISSN: | 1532-7361 |
| DOI: | 10.1016/j.surg.2023.02.020 |
| Online-Zugang: | Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.surg.2023.02.020 Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S0039606023001095 
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| Verfasserangaben: | Niccolò Napoli, Concetta Cacace, Emanuele F. Kauffmann, Leia Jones, Michael Ginesini, Cesare Gianfaldoni, Alice Salamone, Fabio Asta, Allegra Ripolli, Armando Di Dato, Olivier R. Busch, Marie L. Cappelle, Ying Jui Chao, Roeland F. de Wilde, Thilo Hackert, Jin-Young Jang, Bas Groot Koerkamp, Wooil Kwon, Daan Lips, Misha D. P. Luyer, Felix Nickel, Olivier Saint-Marc, Yan-Shen Shan, Baiyong Shen, Fabio Vistoli, Marc G. Besselink, Mohammad Abu Hilal, Ugo Boggi, for the International Consortium on Minimally Invasive Pancreatic Surgery (I-MIPS) |
| Zusammenfassung: | Background - Difficulty scoring systems are important for the safe, stepwise implementation of new procedures. We designed a retrospective observational study for building a difficulty score for robotic pancreatoduodenectomy. - Methods - The difficulty score (PD-ROBOSCORE) aims at predicting severe postoperative complications after robotic pancreatoduodenectomy. The PD-ROBOSCORE was developed in a training cohort of 198 robotic pancreatoduodenectomies and was validated in an international multicenter cohort of 686 robotic pancreatoduodenectomies. Finally, all centers tested the model during the early learning curve (n = 300). Growing difficulty levels (low, intermediate, high) were defined using cut-off values set at the 33rd and 66th percentile (NCT04662346). - Results - Factors included in the final multivariate model were a body mass index of ≥25 kg/m2 for males and ≥30 kg/m2 for females (odds ratio:2.39; P < .0001), borderline resectable tumor (odd ratio:1.98; P < .0001), uncinate process tumor (odds ratio:1.69; P < .0001), pancreatic duct size <4 mm (odds ratio:1.59; P < .0001), American Society of Anesthesiologists class ≥3 (odds ratio:1.59; P < .0001), and hepatic artery originating from the superior mesenteric artery (odds ratio:1.43; P < .0001). In the training cohort, the absolute score value (odds ratio = 1.13; P = .0089) and difficulty groups (odds ratio = 2.35; P = .041) predicted severe postoperative complications. In the multicenter validation cohort, the absolute score value predicted severe postoperative complications (odds ratio = 1.16, P < .001), whereas the difficulty groups did not (odds ratio = 1.94, P = .082). In the learning curve cohort, both absolute score value (odds ratio:1.078, P = .04) and difficulty groups (odds ratio: 2.25, P = .017) predicted severe postoperative complications. Across all cohorts, a PD-ROBOSCORE of ≥12.51 doubled the risk of severe postoperative complications. The PD-ROBOSCORE score also predicted operative time, estimated blood loss, and vein resection. The PD-ROBOSCORE predicted postoperative pancreatic fistula, delayed gastric emptying, postpancreatectomy hemorrhage, and postoperative mortality in the learning curve cohort. - Conclusion - The PD-ROBOSCORE predicts severe postoperative complications after robotic pancreatoduodenectomy. The score is readily available via www.pancreascalculator.com |
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| Beschreibung: | Online verfügbar: 25. März 2023, Artikelversion: 17. Mai 2023 Gesehen am 15.08.2023 |
| Beschreibung: | Online Resource |
| ISSN: | 1532-7361 |
| DOI: | 10.1016/j.surg.2023.02.020 |