Machado, Marcel Autran C.
Mayo Clinic
Department of Surgery, Nove de Julho Hospital, São Paulo, Brazil
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.
The Miami International Evidence-based Guidelines on Minimally Invasive Pancreas Resection
Asbun, Horacio J. , Moekotte, Alma , Vissers, Frederique L., Kunzler, F. , Cipriani, Federica , D’Angelica, Michael I. , Balduzzi, Alberto , Bassi, Claudio , Björnsson, Bergþór , Boggi, Ugo , Callery, Mark P., Chiaro, Marco Del , Coimbra, Felipe José Fernández , Conrad, Claudius , Cook, Andrew , Coppola, Alessandro , Dervenis, Christos, Dokmak, Safi , Edil, Barish H. , Giulianotti, Pier Cristoforo , Hansen, Paul D., Heijde, Nicky van der , Hilst, Jony van , Hester, Caitlin A. , Hogg, Melissa E. , Jarufe, Nicolás , Jeyarajah, D. Rohan, Kim, Song Cheol, Khatkov, Igor , Kokudo, Norihiro , Kooby, David A. , Korrel, Maarten , Leon, Francisco J. de, Lluís, Núria , Lof, Sanne , Demartines, Nicolas , Merchant, Nipun B. , Molenaar, I. Quintus, Moravek, Cassadie, Mou, Yiping , Nealon, William H. , Palanivelu, Chinnusamy, Pessaux, Patrick , Pitt, Henry A. , Primrose, John N., Rawashdeh, Arab , Sanford, Dominic E. , Senthilnathan, Palanisamy, Shrikhande, Shailesh V. , Stauffer, John , Takaori, Kyoichi , Tang, Chung Ngai, Vollmer, Charles M., Wakabayashi, Go , Walsh, R. Matthew , Wang, Shin-E, Zinner, Michael J. , Wolfgang, Christopher L. , Zureikat, Amer H. , Zwart, M. , Conlon, Kevin C. , Kendrick, Michael L., Zeh, Herbert J. , Hilal, Mohammad Abu, Besselink, Marc G. , Primrose, John , Hilal, Mohammad Abu , Demartines, N , A Stauffer, John , Alseidi, Adnan A. , Edwin, Bjørn , Han, Ho-Seong , Jeyarajah, D. Rohan , Keck, Tobias , Machado, Marcel Autran C. , Martinie, John B. , Moravek, Cassadie, Nakamura, Masafumi , Palanivelu, Chinnusamy , Polanco, Patricio Marcelo , Talamonti, Marina , Wang, Shin‐E , Kendrick, Michael L. , Besselink, Marc G , Cipriani, Federica
Annals of Surgery | September 22, 2019 | Volume: 271 | Issue: 1 | Pages: 1-14
Objective: The aim of this study was to develop and externally validate the first evidence-based guidelines on minimally invasive pancreas resection (MIPR) before and during the International Evidence-based Guidelines on Minimally Invasive Pancreas Resection (IG-MIPR) meeting in Miami (March 2019). Summary Background Data: MIPR has seen rapid development in the past decade. Promising outcomes have been reported by early adopters from high-volume centers. Subsequently, multicenter series as well as randomized controlled trials were reported; however, guidelines for clinical practice were lacking. Methods: The Scottisch Intercollegiate Guidelines Network (SIGN) methodology was used, incorporating these 4 items: systematic reviews using PubMed, Embase, and Cochrane databases to answer clinical questions, whenever possible in PICO style, the GRADE approach for assessment of the quality of evidence, the Delphi method for establishing consensus on the developed recommendations, and the AGREE-II instrument for the assessment of guideline quality and external validation. The current guidelines are cosponsored by the International Hepato-Pancreato-Biliary Association, the Americas Hepato-Pancreato-Biliary Association, the Asian-Pacific Hepato-Pancreato-Biliary Association, the European-African Hepato-Pancreato-Biliary Association, the European Association for Endoscopic Surgery, Pancreas Club, the Society of American Gastrointestinal and Endoscopic Surgery, the Society for Surgery of the Alimentary Tract, and the Society of Surgical Oncology. Results: After screening 16,069 titles, 694 studies were reviewed, and 291 were included. The final 28 recommendations covered 6 topics; laparoscopic and robotic distal pancreatectomy, central pancreatectomy, pancreatoduodenectomy, as well as patient selection, training, learning curve, and minimal annual center volume required to obtain optimal outcomes and patient safety. Conclusion: The IG-MIPR using SIGN methodology give guidance to surgeons, hospital administrators, patients, and medical societies on the use and outcome of MIPR as well as the approach to be taken regarding this challenging type of surgery.