• Maarten Korrel, Jony van Hilst, Koop Bosscha, BuschOlivier R CORCAmsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam.Cancer Center Amsterdam., Freek Daams, Ronald van Dam, van EijckCasper H JCHJDepartment of Surgery, Erasmus MC Cancer Institute, Rotterdam., Sebastiaan Festen, Bas Groot Koerkamp, Erwin van der Harst, Daan J Lips, Misha D Luyer, Vincent E de Meijer, MieogJ Sven DJSDDepartment of Surgery, Leiden University Medical Center, Leiden., I Quintus Molenaar, Gijs A Patijn, Hjalmar C van Santvoort, George P van der Schelling, StommelMartijn W JMWJDepartment of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands., Marc G Besselink, and Dutch Pancreatic Cancer Group.
• Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam.
• Ann. Surg. 2024 Feb 1; 279 (2): 323330323-330.

ObjectiveTo assess the nationwide long-term uptake and outcomes of minimally invasive distal pancreatectomy (MIDP) after a nationwide training program and randomized trial.BackgroundTwo randomized trials demonstrated the superiority of MIDP over open distal pancreatectomy (ODP) in terms of functional recovery and hospital stay. Data on implementation of MIDP on a nationwide level are lacking.MethodsNationwide audit-based study including consecutive patients after MIDP and ODP in 16 centers in the Dutch Pancreatic Cancer Audit (2014 to 2021). The cohort was divided into three periods: early implementation, during the LEOPARD randomized trial, and late implementation. Primary endpoints were MIDP implementation rate and textbook outcome.ResultsOverall, 1496 patients were included with 848 MIDP (56.5%) and 648 ODP (43.5%). From the early to the late implementation period, the use of MIDP increased from 48.6% to 63.0% and of robotic MIDP from 5.5% to 29.7% ( P <0.001). The overall use of MIDP (45% to 75%) and robotic MIDP (1% to 84%) varied widely between centers ( P <0.001). In the late implementation period, 5/16 centers performed >75% of procedures as MIDP. After MIDP, in-hospital mortality and textbook outcome remained stable over time. In the late implementation period, ODP was more often performed in ASA score III-IV (24.9% vs. 35.7%, P =0.001), pancreatic cancer (24.2% vs. 45.9%, P <0.001), vascular involvement (4.6% vs. 21.9%, P <0.001), and multivisceral involvement (10.5% vs. 25.3%, P <0.001). After MIDP, shorter hospital stay (median 7 vs. 8 d, P <0.001) and less blood loss (median 150 vs. 500 mL, P <0.001), but more grade B/C postoperative pancreatic fistula (24.4% vs. 17.2%, P =0.008) occurred as compared to ODP.ConclusionA sustained nationwide implementation of MIDP after a successful training program and randomized trial was obtained with satisfactory outcomes. Future studies should assess the considerable variation in the use of MIDP between centers and, especially, robotic MIDP.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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