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Changing trends and outcomes associated with the adoption of minimally invasive pancreatic surgeries: A single institution experience with 150 consecutive procedures in Southeast Asia

BACKGROUND: Minimally invasive pancreatic surgeries (MIPS) are increasingly adopted worldwide. However, it remains uncertain if these reported experiences are reproducible throughout the world today. This study examines the safety and evolution of MIPS at a single institution in Southeast Asia. METH...

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Autores principales: Goh, Brian K., Low, Tze Yi, Koh, Ye Xin, Lee, Ser Yee, Teo, Jin-Yao, Kam, Juinn Huar, Jeyaraj, Prema Raj, Cheow, Peng-Chung, Chow, Pierce K., Ooi, London L., Chung, Alexander Y., Chan, Chung Yip
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7597893/
https://www.ncbi.nlm.nih.gov/pubmed/31571669
http://dx.doi.org/10.4103/jmas.JMAS_127_19
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author Goh, Brian K.
Low, Tze Yi
Koh, Ye Xin
Lee, Ser Yee
Teo, Jin-Yao
Kam, Juinn Huar
Jeyaraj, Prema Raj
Cheow, Peng-Chung
Chow, Pierce K.
Ooi, London L.
Chung, Alexander Y.
Chan, Chung Yip
author_facet Goh, Brian K.
Low, Tze Yi
Koh, Ye Xin
Lee, Ser Yee
Teo, Jin-Yao
Kam, Juinn Huar
Jeyaraj, Prema Raj
Cheow, Peng-Chung
Chow, Pierce K.
Ooi, London L.
Chung, Alexander Y.
Chan, Chung Yip
author_sort Goh, Brian K.
collection PubMed
description BACKGROUND: Minimally invasive pancreatic surgeries (MIPS) are increasingly adopted worldwide. However, it remains uncertain if these reported experiences are reproducible throughout the world today. This study examines the safety and evolution of MIPS at a single institution in Southeast Asia. METHODS: This is a retrospective review of 150 consecutive patients who underwent MIPS between 2006 and 2018 of which 135 cases (90%) were performed since 2012. To determine the evolution of MIPS, the study population was stratified into 3 equal groups of 50 patients. Comparison was also made between pancreatoduodenectomies (PD), distal pancreatectomies (DP) and other pancreatic surgeries. RESULTS: One hundred and fifty patients underwent MIPS (103 laparoscopic, 45 robotic and 2 hand-assisted). Forty-three patients underwent PD, 93 DP and 14 other MIPS. There were 21 (14.0%) open conversions. There was an exponential increase in caseload over the study period. Comparison across the 3 time periods demonstrated that patients were significantly more likely to have a higher American Society of Anesthesiologists score, older, undergo PD and a longer operation time. The conversion rate decreased from 28% to 0% and increased again to 14% across the 3 time periods. Comparison between the various types of MIPS demonstrated that patients who underwent PD were significantly older, more likely to have symptomatic tumours, had longer surgery time, increased blood loss, increased frequency of extended pancreatectomies, increased frequency of hybrid procedures, longer post-operative stay, increased post-operative morbidity rate and increased post-operative major morbidity rate. CONCLUSION: The case volume of MIPS increased rapidly at our institution over the study period. Furthermore, although the indications for MIPS expanded to include more complex procedures in higher risk patients, there was no change in key perioperative outcomes.
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spelling pubmed-75978932020-11-03 Changing trends and outcomes associated with the adoption of minimally invasive pancreatic surgeries: A single institution experience with 150 consecutive procedures in Southeast Asia Goh, Brian K. Low, Tze Yi Koh, Ye Xin Lee, Ser Yee Teo, Jin-Yao Kam, Juinn Huar Jeyaraj, Prema Raj Cheow, Peng-Chung Chow, Pierce K. Ooi, London L. Chung, Alexander Y. Chan, Chung Yip J Minim Access Surg Original Article BACKGROUND: Minimally invasive pancreatic surgeries (MIPS) are increasingly adopted worldwide. However, it remains uncertain if these reported experiences are reproducible throughout the world today. This study examines the safety and evolution of MIPS at a single institution in Southeast Asia. METHODS: This is a retrospective review of 150 consecutive patients who underwent MIPS between 2006 and 2018 of which 135 cases (90%) were performed since 2012. To determine the evolution of MIPS, the study population was stratified into 3 equal groups of 50 patients. Comparison was also made between pancreatoduodenectomies (PD), distal pancreatectomies (DP) and other pancreatic surgeries. RESULTS: One hundred and fifty patients underwent MIPS (103 laparoscopic, 45 robotic and 2 hand-assisted). Forty-three patients underwent PD, 93 DP and 14 other MIPS. There were 21 (14.0%) open conversions. There was an exponential increase in caseload over the study period. Comparison across the 3 time periods demonstrated that patients were significantly more likely to have a higher American Society of Anesthesiologists score, older, undergo PD and a longer operation time. The conversion rate decreased from 28% to 0% and increased again to 14% across the 3 time periods. Comparison between the various types of MIPS demonstrated that patients who underwent PD were significantly older, more likely to have symptomatic tumours, had longer surgery time, increased blood loss, increased frequency of extended pancreatectomies, increased frequency of hybrid procedures, longer post-operative stay, increased post-operative morbidity rate and increased post-operative major morbidity rate. CONCLUSION: The case volume of MIPS increased rapidly at our institution over the study period. Furthermore, although the indications for MIPS expanded to include more complex procedures in higher risk patients, there was no change in key perioperative outcomes. Wolters Kluwer - Medknow 2020 2019-08-06 /pmc/articles/PMC7597893/ /pubmed/31571669 http://dx.doi.org/10.4103/jmas.JMAS_127_19 Text en Copyright: © 2019 Journal of Minimal Access Surgery http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Goh, Brian K.
Low, Tze Yi
Koh, Ye Xin
Lee, Ser Yee
Teo, Jin-Yao
Kam, Juinn Huar
Jeyaraj, Prema Raj
Cheow, Peng-Chung
Chow, Pierce K.
Ooi, London L.
Chung, Alexander Y.
Chan, Chung Yip
Changing trends and outcomes associated with the adoption of minimally invasive pancreatic surgeries: A single institution experience with 150 consecutive procedures in Southeast Asia
title Changing trends and outcomes associated with the adoption of minimally invasive pancreatic surgeries: A single institution experience with 150 consecutive procedures in Southeast Asia
title_full Changing trends and outcomes associated with the adoption of minimally invasive pancreatic surgeries: A single institution experience with 150 consecutive procedures in Southeast Asia
title_fullStr Changing trends and outcomes associated with the adoption of minimally invasive pancreatic surgeries: A single institution experience with 150 consecutive procedures in Southeast Asia
title_full_unstemmed Changing trends and outcomes associated with the adoption of minimally invasive pancreatic surgeries: A single institution experience with 150 consecutive procedures in Southeast Asia
title_short Changing trends and outcomes associated with the adoption of minimally invasive pancreatic surgeries: A single institution experience with 150 consecutive procedures in Southeast Asia
title_sort changing trends and outcomes associated with the adoption of minimally invasive pancreatic surgeries: a single institution experience with 150 consecutive procedures in southeast asia
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7597893/
https://www.ncbi.nlm.nih.gov/pubmed/31571669
http://dx.doi.org/10.4103/jmas.JMAS_127_19
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