Multicenter comparison of totally laparoscopic and totally robotic pancreaticoduodenectomy: Propensity score and learning curve‐matching analyses

Author(s):  
Hyeyeon Kim ◽  
Sung Hoon Choi ◽  
Jae Young Jang ◽  
Munseok Choi ◽  
Jae Hoon Lee ◽  
...  
2021 ◽  
Author(s):  
Shin-Hoo Park ◽  
Yun-Suhk Suh ◽  
Tae-Han Kim ◽  
Yoon-Hee Choi ◽  
Jong-Ho Choi ◽  
...  

Abstract Background: This study aimed to evaluate the surgical outcome and quality of life (QoL) of totally laparoscopic total gastrectomy (TLTG) compared with laparoscopy-assisted total gastrectomy (LATG) in patients with clinical stage I gastric cancer.Methods: From 2012 to 2018, EGC patients who underwent TLTG (n=223), including the first case with intracorporeal hemi-double stapling, were matched to those who underwent LATG (n=114) with extracorporeal circular stapling, using 2:1 propensity score matching (PSM). Prospectively collected morbidity was compared between the TLTG and LATG groups in conjunction with the learning curve. The European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaires QLQ-C30, STO22, and OG25 were prospectively surveyed during postoperative 1 year for patient subgroups.Results: After PSM, grade I pulmonary complication rate was lower in the TLTG group (n=213) than in the LATG group (n=111) (0.5% vs. 5.4%, P=0.007). Other complications were not different between the groups. The learning curve of TLTG was overcome at the 26th case in terms of the comprehensive complication index. The TLTG group after learning curve showed lower grade I pulmonary complication rate than the matched LATG group (0.5% vs. 4.7%, P=0.024). Regarding postoperative QoL, the TLTG group (n=63) revealed less dysphagia (P=0.028), pain (P=0.028), eating restriction (P=0.006), eating (P=0.004), odynophagia (P=0.023) than the LATG group (n=21). Multivariate analyses for each QoL item demonstrated that TLTG was the only common independent factor for better QoL.Conclusions: TLTG reduced pulmonary complications and provided better QoL in dysphagia, pain, eating, odynophagia than LATG for patients with clinical stage I gastric cancer.


2019 ◽  
Vol 18 (1) ◽  
pp. e794-e795
Author(s):  
A. Olivero ◽  
A. Galfano ◽  
S. Secco ◽  
M. Piccinelli ◽  
D. Panarello ◽  
...  

HPB ◽  
2020 ◽  
Vol 22 ◽  
pp. S132
Author(s):  
B.R. Harris ◽  
K.A. Musgrove ◽  
M.E. Hogg ◽  
J.W. Marsh ◽  
H.J. Zeh ◽  
...  

HPB ◽  
2016 ◽  
Vol 18 ◽  
pp. e101
Author(s):  
M.U. Butt ◽  
H. Osman ◽  
H. Aderianwalla ◽  
R. Hellums ◽  
S. Furlough ◽  
...  

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Sa Mendes ◽  
A Oliveira ◽  
R Campante Teles ◽  
P Araujo Goncalves ◽  
J Brito ◽  
...  

Abstract Background Vascular complications increase morbidity and mortality in transcatheter aortic valve implantation (TAVI). A collagen plug-based closure device - MANTA® was recently introduced as an alternative to the suture-mediated ProGlide® vascular closure device (VCD). Data regarding the efficacy and safety comparing both VCD is scarce. The present study sought to compare the effectiveness of both devices. Methods Single center retrospective analysis on prospectively collected data of 300 consecutive patients who underwent TAVI using MANTA® or ProGlide® since 2018. A 1:1 propensity-score matched population derived by a multivariate logistic regression model based on age, sex, body mass index, pre-procedural haemoglobin, EuroSCORE II, main access calcification and the sheath-to-artery ratio. The primary endpoint was the composite of major or life-threatening bleeding (VARC-2 definition), femoral artery stenosis/dissection, pseudoaneurysm and need for endovascular/surgical bailout intervention. Results The propensity score matching resulted in 129 matched pairs. The median age was 84 years old [IQR 80–87], 42% males with a median EuroSCOREII of 4.29% [IQR 3.05–6.24]. There were no differences in the primary endpoint between MANTA ® and ProGlide® cohorts (3.9% vs 7.8%, p=0.287, respectively). The rates of the primary endpoint with the MANTA® device decreased with center experience, with relatively steep learning curve effect concerning device success. Major or life-threatening bleeding (3.1% vs 5.4%, p=0.540) and pseudoaneurysm (0.8% vs 2.3%, p=0.622) occurred less frequently in MANTA® cohort, but the differences did not reach statistical significance. Endovascular (stent or balloon) or surgical rescue intervention (9.3% vs 5.4%, p=0.341) and femoral artery stenosis/dissection (6.2% vs 3.1%, p=0.376), were also similar rates. In ProGlide® cohort, to achieve VCD success (without primary endpoint events), 15.5% needed more than 2 devices, significantly different from MANTA ® (p<0,001). Conclusions In patients undergoing transfemoral TAVI, the MANTA® VCD showed a similar efficacy and safety compared to the ProGlide® device and it reduced significantly the need of additional VCDs for completion of hemostasis. These results were obtained despite a clear learning curve associated with MANTA. Funding Acknowledgement Type of funding source: None


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