Predictors of achieving a textbook outcome following robotic left-sided pancreatectomy: multicentre analysis
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Recent Brescia guidelines suggest proficiency in robotic left-sided pancreatectomy (RLP) occurs after the first 21 cases (competency phase). This study reports textbook outcome (TO) rates in the competency and proficiency phases following RLP, and predictors of achieving TO. METHODS: A retrospective cohort study of all RLP procedures from six UK centres was undertaken from July 2014 to August 2024. TO was defined as a composite of hospital length of stay, major morbidity, in-hospital mortality, 90-day readmission, and clinically relevant postoperative pancreatic fistula (CR-POPF). Multivariable logistic regression analysis was used to model predictors of TO. RESULTS: In all, 281 patients underwent RLP. The median number of laparoscopic left-sided pancreatectomies undertaken before starting the RLP programme was 70 (interquartile range 40-175) per centre. In all, 109 patients underwent RLP in the competency phase and 172 underwent RLP in the proficiency phase; TO was achieved in 57 patients (52.3%) and 86 patients (50.0%), respectively (P = 0.801). Major morbidity occurred in 38 patients (13.5%), 68 patients were readmitted within 90 days (24.2%), and 57 patients had CR-POPF (20.3%). Patients in the proficiency phase had a longer operating time (315 versus 230 minutes; P < 0.0001), a lower rate of splenic preservation (23 versus 27; P = 0.023), and a lower rate of vascular infiltration (12 versus 22; P = 0.002) than patients in the competency phase. TO was less likely with a prolonged operation time (odds ratio 0.82 per hour; 95% c.i. 0.70 to 0.95; P = 0.010) with a non-linear trend noted. CONCLUSION: TO after RLP was achieved in half the resected patients in this UK series. There was no difference in the TO rate between the competency and proficiency phases, and previous experience with laparoscopic left-sided pancreatectomy may have contributed to this.
Source: BJS Open
Authors: Abdullah K Malik, Bhargav Chikkala, Claire Ramage, Samuel J Tingle, Jason Kho, Zaed Hamady, Ali Arshad, Hassaan Bari, Andrea Sheel, Ryan Baron, Declan Dunne, Timothy Pencaval, Rajiv Lahiri, Daniel Hughes, Michael Silva, Zahir Soonawalla, Ricky Bhogal, Jeremy J French, Jose M Ramia, Jawad Ahmad, Steven A White, Sanjay Pandanaboyana, the UK Robotic Pancreatic Surgery Study Group, Abdullah K Malik, Bhargav Chikkala, Zaed Hamady, Ali Arshad, Hassaan Bari, Andrea Sheel, Ryan Baron, Declan Dunne, Timothy Pencaval, Rajiv Lahiri, Michael Silva, Zahir Soonawalla, Ricky Bhogal, Jeremy J French, Jawad Ahmad, Steven A White, Sanjay Pandanaboyana
Institutions: Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle University, University Hospital Southampton NHS Foundation Trust, University of Southampton, University Hospital Coventry, University Hospitals Coventry and Warwickshire NHS Trust, Liverpool University Hospitals NHS Foundation Trust, Royal Surrey NHS Foundation Trust, Oxford University Hospitals NHS Trust, Royal Marsden NHS Foundation Trust, Hospital General Universitario de Alicante Doctor Balmis
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,881
Funders: University Hospital Southampton NHS Foundation Trust, Royal Marsden NHS Foundation Trust, University of Oxford, Newcastle upon Tyne Hospitals NHS Foundation Trust, Oxford University Hospitals NHS Foundation Trust, Liverpool University Hospitals NHS Foundation Trust, University Hospitals Coventry and Warwickshire NHS Trust, Medical Research Council
OpenAlex ID: W7125370552