Citations 2
International Reference Values for Surgical Outcomes of Total Pancreatectomy
Berchtold, Caroline , Kuemmerli, Christoph, Li, Zhihao , Eden, Janina , Wu, Pengfei , Cecchetto, Sara Nicole, Kendrick, Michael L. , Pecorelli, Nicolò , Guarneri, Giovanni , Farooqui, Waqas , Tschuor, Christoph , Burgdorf, Stefan Kobbelgaard , Mühlhäusser, Julia , Gass, Jörn‐Markus , Koh, Ye-Xin, Seip, Tomas, Santibañes, Martín de , Todeschini, Letizia , Marchegiani, Giovanni, Belfil, Nadiya , Boggi, Ugo, Cappelle, Marie , Koerkamp, Bas Groot , Dutkowski, Philipp , Hackert, Thilo , Truty, Mark J. , Group, Outcomes for Total Pancreatectomy, Valle, Valentina , Giulianotti, Pier Cristoforo , Pessaux, Patrick, Thapa, Prabin , Kuzman, Matta , Pandanaboyana, Sanjay, He, Jin , Kendrick, Michael, Truty, Mark, Li, Zhihao , Groot Koerkamp, Bas , Müller, Philip C , Breuer, Eva , Vallorani, Alessia , Hansen, Carsten Palnæs , Guidetti, Cristiano , Campbell, Brady A. , Cecchetto, Sara Nicole, Gudmundsdottir, Hallbera , Starlinger, Patrick , Goh, Brian K P , Koh, Ye-Xin , Rebelo, Artur , Kleeff, Jorg H. , Marchegiani, Giovanni , Lesurtel, Mickaël , Machado, Marcel Autran C. , Kauffmann, Emanuele F. , Benedetto, Fabrizio Di , Roberts, Keith John , Nevler, Avinoam , Lavu, Harish , Nickel, Felix , He, Jing , Falconi, Massimo , Billeter, Adrian T. , Müller-Stich, Beat Peter , Group, Outcomes for Total Pancreatectomy, Halle-Smith, James Michael , Giannone, Fabio , Pessaux, Patrick , Sánchez‐Velázquez, Patricia , Maharjan, Dhiresh Kumar , Torres, Orlando Jorge Martins
JAMA Surgery | November 12, 2025 | Volume: 161 | Issue: 1 | Pages: 50
Importance Total pancreatectomy (TP) is indicated for advanced pancreatic cancer or multifocal tumors. Furthermore, TP may be performed to avoid the risk of pancreatic fistula in selected patients to improve the perioperative risk profile. Objective To define reference values for TP based on a low-risk cohort treated at expert centers. Design, Setting, and Participants This multicenter study analyzed outcomes from patients undergoing primary TP for malignant or benign lesions from 25 international expert centers from January 2017 to November 2023. Low-risk patients undergoing TP (LR-TP) were without vascular resections or significant comorbidities. Exposures TP. Main Outcomes and Measures Twenty reference values were derived from the 75th or the 25th percentile of the median values of all centers. Outcomes of LR-TP were compared with a cohort of TP with vascular resection, TP due to high-risk pancreatic anastomosis, and the benchmark values for low-risk pancreatoduodenectomy. Results Of 994 patients, 333 (33.5%; median [IQR] age, 66 [58-72] years; 171 male [51.4%]) qualified as the LR-TP cohort. Reference values included blood loss (≤1000 mL), major complications (≤37%), 3-month postoperative mortality (<6%), and retrieved lymph nodes (≥29). Compared with TP with vascular resections, reference cutoffs were not met for major complications (51% vs LR-TP ≤37%) and 90-day mortality (11% vs LR-TP ≤6%). For TP due to high-risk anastomosis, failure to rescue rate (38% vs ≤6%) and 90-day mortality (11% vs LR-TP ≤6%) were not met. Compared with pancreatoduodenectomy, reference values for postoperative mortality were 3 times higher for LR-TP (≤2% vs ≤6%) and less for resected lymph nodes (≥16 vs ≥29). Conclusions and Relevance This case-control study provided global reference values for TP, indicating significantly higher postoperative morbidity and mortality compared with pancreatoduodenectomy. Perioperative morbidity of TP was especially increased in patients with vascular resections. These reference values can serve for quality control of pancreatic surgery.
Novel Benchmark for Robotic Liver Resection – Bridging Tradition with Innovation
Pfister, Matthias , Ma, Yong , Yang, Guangchao, Li, Linqiang , Song, Xuan , Venezia, Raphael, Jeddou, Heithem , Floc’h, Bastien Le, Valverde, A. , Péru, N. , Pessaux, Patrick, Salloum, Chady , Blanc, P., Scatton, Olivier , Tzedakis, Stylianos , Fuks, David , Chaoui, Ismaël, Silva, Silvia Gomes da, Sobral, M., Centonze, Leonardo , Zhu, Zhu , Ratti, Francesca, Rompianesi, Gianluca , Shah, Jimmy, Wakabayashi, Taiga , Coelho, Fabrício Ferreira , Castillo‐Flores, Samy , Viti, Virginia, Boggi, Ugo , Han, Ho-Seong, Panaro, Fabrizio , Wakabayashi, Go, Ielpo, Benedetto , Mejia, Alejandro , Troisi, Roberto I., Choi, Gi Hong , Liu, Rong , Sucandy, Iswanto, Rela, Mohamed , D’Hondt, Mathieu , Bröering, Dieter C. , Clavien, Pierre‐Alain , Li, Zhihao , Dong, Yawen , Clavien, Pierre-Alain , Centonze, Leonardo , Li, Zhihao , Li, Zhihao, Raptis, Dimitri , Song, Xuan, Millet, Guillaume, Truant, Stéphanie , Venezia, Raphael, Pessaux, Patrick , Giannone, Fabio , Mabrut, Jean‐Yves , Mohkam, Kayvan , Cunha, António Sá , Roy, Bertrand Le , Goumard, Claire , Fuks, David , Rammohan, Ashwin , Silva, Silvia Gomes da, López‐López, Víctor , Ratti, Francesca, Marino, Rebecca , Müller, Philip C , Lee, Bo Ram , Kato, Yutaro , Polanco, Patricio Marcelo , Goh, Brian K P , Cheung, Tan To , Efanov, Mikhail G. , Machado, Marcel Cerqueira César , Herman, Paulo , Müller-Stich, Beat Peter , Starlinger, Patrick , Martinie, John B. , Aldrighetti, Luca , Chen, Guodong , Robles, R , Benedetto, Fabrizio Di , Marques, Hugo P. , Sucandy, Iswanto , Brustia, Raffaele , Soubrane, Olivier
Annals of Surgery | May 20, 2025 | Volume: No volume available | Issue: No issue available | Pages: No page available
Objective: To establish benchmark cutoffs for robotic liver resection (R-LR), encompassing both major and minor resections, and to determine the impact of patient selection on outcomes. Background: R-LR is a key advancement in minimally invasive liver surgery but lacks standardized benchmarks, especially for minor resections. While guidelines endorse R-LR, its role in optimizing outcomes remains unclear. This study establishes the first benchmarks for R-LR, enabling comparisons across surgical modalities and refining patient selection. Methods: This retrospective, multicenter study analyzed consecutive adult patients undergoing R-LR at 30 international centers (2020–2023). Benchmark centers had an annual case volume of ≥15 R-LR. Benchmark criteria included ASA ≤2, no major comorbidities, no prior liver resections, and Child-Pugh A status. Benchmark cutoffs for 14 key outcomes were set at the 50th and 75th percentiles of median values across benchmark centers. Multivariable logistic regression identified predictors of textbook outcomes. Results: Eighteen high-volume centers contributed 4028 cases with 2632 (65.3%) meeting benchmark criteria. Malignancy was the indication in 29.6%, most commonly hepatocellular carcinoma followed by colorectal liver metastases. Major liver resection was performed in 42.6%. The distribution of Iwate difficulty scores was low (25.4%), intermediate (53.9%), advanced (15.9%), and expert (4.9%). Benchmark cutoffs were established for minor and major resection, and stratified by Iwate low (0-3), intermediate (4-6) and high (7-12): Open conversion (≤6.5% minor, ≤10.5% major), major complications within 90 days (≤5.2% minor, ≤16.7% major), R1 resection (≤9.2% minor, ≤6.7% major). Benchmark cases performed at low-volume centers were able to achieve outcomes within the corresponding benchmark cutoffs. In fact, patient selection reflected by the proportion of benchmark patients, rather than case volume, was associated with textbook outcomes. Conclusions: This study defines R-LR benchmarks, emphasizing patient selection over center volume for optimal outcomes. Benchmark cutoffs guide training and support the expansion of R-LR.