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7. Surgery for multiple endocrine neoplasia type 1-related insulinoma

Author

van Beek, D. J., Nell, S., Verkooijen, H. M., Borel Rinkes, I. H. M., Valk, G. D., Vriens, M. R., Goudet, P., Vella, A., Donegan, D., Bartsch, D. K., Manoharan, J., Perrier, N. D., Christakis, I., Brandi, M. L., Zarnegar, R., Postma, E. L., Kebebew, E., Nockel, P., Brunaud, L., Pasternak, J. D., Kluijfhout, W. P., Sturgeon, C., Giri, S., Bonsing, B. A., van Eijck, C. H., van Goor, H., de Kleine, R. H. J., van Dijkum, E. J. Nieveen, Dejong, C. H. C., Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Clinical Genetics, and Department of Finance

Subjects
Male, endocrine system diseases, Kaplan-Meier Estimate, 0302 clinical medicine, Postoperative Complications, Multiple endocrine neoplasia, Child, Aged, 80 and over, Middle Aged, medicine.anatomical_structure, Treatment Outcome, 030220 oncology & carcinogenesis, HPB, Child, Preschool, Original Article, Female, Pancreas, hormones, hormone substitutes, and hormone antagonists, Adult, medicine.medical_specialty, endocrine system, Adolescent, Enucleation, Clinical Decision-Making, 030209 endocrinology & metabolism, Hypoglycemia, 03 medical and health sciences, Young Adult, Pancreatectomy, medicine, Multiple Endocrine Neoplasia Type 1, Humans, MEN1, General, Survival rate, Insulinoma, Aged, Retrospective Studies, business.industry, Original Articles, medicine.disease, Surgery, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Pancreatic Neoplasms, Localized disease, Neoplasm Recurrence, Local, business, Follow-Up Studies
Abstract

Background Insulinomas are found in 10–15 per cent of patients with multiple endocrine neoplasia type 1 (MEN1) and lead to life‐threatening hypoglycaemia. Surgical outcome and the optimal surgical strategy for MEN1‐related insulinoma are unknown. Methods Patients with MEN1‐related insulinomas were identified in 46 centres in Europe and North America between 1990 and 2016. Insulinomas were considered localized if the lesion was in the pancreatic head or body/tail. Patients with pancreatic neuroendocrine tumours throughout the pancreas were suspected of having multifocal insulinoma. The primary outcome was postoperative hypoglycaemia, defined as persistent hypoglycaemia, or recurrent hypoglycaemia caused by a new insulinoma or insulin‐producing liver metastases. Hypoglycaemia‐free survival was estimated by the Kaplan–Meier method. Results Ninety‐six patients underwent resection for MEN1‐related insulinoma. Sixty‐three and 33 patients had localized and multifocal insulinomas respectively. After a median follow‐up of 8 (range 1–22) years, one patient (1 per cent) had persistent disease and six (6 per cent) had developed recurrent disease, of whom four had a new insulinoma. The 10‐year hypoglycaemia‐free survival rate was 91 (95 per cent c.i. 80 to 96) per cent. Of those with localized disease, 46 patients underwent pancreatic resection and 17 enucleation. One of these patients had persistent disease and one developed recurrent insulinoma. Among patients with multifocal disease, three developed new insulinomas and two developed insulin‐producing liver metastases. Conclusion Surgery for MEN1‐related insulinoma is more successful than previously thought., In this cohort of 96 patients with resected multiple endocrine neoplasia 1 (MEN1)‐related insulinomas, seven patients (7 per cent) developed postoperative persistent or recurrent hypoglycaemia after a median follow‐up of 8 years. The 10‐year hypoglycaemia‐free survival rate was 91 (95 per cent c.i. 80 to 96) per cent. For patients with localized insulinoma, enucleation seems the preferred procedure. PPPD, pylorus‐preserving pancreatoduodenectomy. Outcomes good

Published
2020

11. Defining Major Surgery: A Delphi Consensus Among European Surgical Association (ESA) Members

Author

Martin, D., Mantziari, S., Demartines, N., Hubner, M., Bismuth, H., Sarr, M. G., Strasberg, S. M., Wexner, S. D., Adham, M., Altomare, D. F., Andersson, R., Bechstein, W., Biondo, S., Bockhorn, M., Bonavina, L., Rituerto, D. C., Clavien, P. -A., De Manzini, N., Decker, G., Dejong, C. H., Dervenis, C., Farges, O., Figueras, J., Fingerhut, A. L., Friess, H., Glehen, O., Gnant, M., Gutschow, C., Hahnloser, D., Hamberger, B., Hamming, J. F., Holscher, A. H., Izbicki, J. R., Jonas, S., Karamarkovic, A., Kehlet, H., Leppaniemi, A. K., Lerut, J., Line, P. -D., Lodge, J. P. A., Meakins, J. L., Montorsi, M., Nafteux, P., Naredi, P., Olah, A., Panis, Y., Pardo, F., Parks, R. W., Pedrazzoli, S., Pessaux, P., Marques, H. P., Poggioli, G., Popescu, I., Puolakkainen, P. A., Ramia Angel, J. M., Rasanen, J., Reynolds, J. V., Rosati, R., Saeger, H. -D., Schneeberger, S., Schneider, P. M., Soreide, K., Stippel, D., Toso, C., Tuech, J. -J., Tukiainen, E. J., Van Hillegersberg, R., Wijnhoven, B., Winter, D. C., Zaninotto, G., Surgery, Martin, D., Mantziari, S., Demartines, N., Hubner, M., Bismuth, H., Sarr, M. G., Strasberg, S. M., Wexner, S. D., Adham, M., Altomare, D. F., Andersson, R., Bechstein, W., Biondo, S., Bockhorn, M., Bonavina, L., Rituerto, D. C., Clavien, P. -A., De Manzini, N., Decker, G., Dejong, C. H., Dervenis, C., Farges, O., Figueras, J., Fingerhut, A. L., Friess, H., Glehen, O., Gnant, M., Gutschow, C., Hahnloser, D., Hamberger, B., Hamming, J. F., Holscher, A. H., Izbicki, J. R., Jonas, S., Karamarkovic, A., Kehlet, H., Leppaniemi, A. K., Lerut, J., Line, P. -D., Lodge, J. P. A., Meakins, J. L., Montorsi, M., Nafteux, P., Naredi, P., Olah, A., Panis, Y., Pardo, F., Parks, R. W., Pedrazzoli, S., Pessaux, P., Marques, H. P., Poggioli, G., Popescu, I., Puolakkainen, P. A., Ramia Angel, J. M., Rasanen, J., Reynolds, J. V., Rosati, R., Saeger, H. -D., Schneeberger, S., Schneider, P. M., Soreide, K., Stippel, D., Toso, C., Tuech, J. -J., Tukiainen, E. J., Van Hillegersberg, R., Wijnhoven, B., Winter, D. C., Zaninotto, G., Martin D., Mantziari S., Demartines N., Hubner M., Bismuth H., Sarr M.G., Strasberg S.M., Wexner S.D., Adham M., Altomare D.F., Andersson R., Bechstein W., Biondo S., Bockhorn M., Bonavina L., Rituerto D.C., Clavien P.-A., De Manzini N., Decker G., Dejong C.H., Dervenis C., Farges O., Figueras J., Fingerhut A.L., Friess H., Glehen O., Gnant M., Gutschow C., Hahnloser D., Hamberger B., Hamming J.F., Holscher A.H., Izbicki J.R., Jonas S., Karamarkovic A., Kehlet H., Leppaniemi A.K., Lerut J., Line P.-D., Lodge J.P.A., Meakins J.L., Montorsi M., Nafteux P., Naredi P., Olah A., Panis Y., Pardo F., Parks R.W., Pedrazzoli S., Pessaux P., Marques H.P., Poggioli G., Popescu I., Puolakkainen P.A., Ramia Angel J.M., Rasanen J., Reynolds J.V., Rosati R., Saeger H.-D., Schneeberger S., Schneider P.M., Soreide K., Stippel D., Toso C., Tuech J.-J., Tukiainen E.J., Van Hillegersberg R., Wijnhoven B., Winter D.C., Zaninotto G., ESA Study Group, Sarr, M.G., Strasberg, S.M., Wexner, S.D., Altomare, D.F., Rituerto, D.C., Clavien, P.A., Dejong, C.H., Fingerhut, A.L., Hamming, J.F., Hölscher, A.H., Izbicki, J.R., Leppäniemi, A.K., Line, P.D., Lodge, JPA, Meakins, J.L., Oláh, A., Parks, R.W., Marques, H.P., Puolakkainen, P.A., Ramia Angel, J.M., Reynolds, J.V., Saeger, H.D., Schneider, P.M., Søreide, K., Tuech, J.J., Tukiainen, E.J., Winter, D.C., Institut de Recherche sur les Maladies Virales et Hépatiques (IVH), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), University of Zurich, Demartines, Nicolas, and Toso, Christian

Subjects
Male, medicine.medical_specialty, Blood transfusion, Consensus, Delphi Technique, medicine.medical_treatment, Delphi method, 610 Medicine & health, Consensu, Likert scale, 03 medical and health sciences, Surgeon, 0302 clinical medicine, Aged, Europe, Humans, Middle Aged, Societies, Medical, Surgeons, Surgical Procedures, Operative/methods, Medical, major surgery, Delphi consensus definition, medicine, Operative / methods, 10217 Clinic for Visceral and Transplantation Surgery, Surgical Procedures, ddc:617, business.industry, Perioperative, Vascular surgery, 2746 Surgery, 3. Good health, Cardiac surgery, Surgery, Cardiothoracic surgery, 030220 oncology & carcinogenesis, Surgical Procedures, Operative, 030211 gastroenterology & hepatology, Societies, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Abdominal surgery, Human
Abstract

Background: Major surgery is a term frequently used but poorly defined. The aim of the present study was to reach a consensus in the definition of major surgery within a panel of expert surgeons from the European Surgical Association (ESA). Methods: A 3-round Delphi process was performed. All ESA members were invited to participate in the expert panel. In round 1, experts were inquired by open- and closed-ended questions on potential criteria to define major surgery. Results were analyzed and presented back anonymously to the panel within next rounds. Closed-ended questions in round 2 and 3 were either binary or statements to be rated on a Likert scale ranging from 1 (strong disagreement) to 5 (strong agreement). Participants were sent 3 reminders at 2-week intervals for each round. 70% of agreement was considered to indicate consensus. Results: Out of 305 ESA members, 67 (22%) answered all the 3 rounds. Significant comorbidities were the only preoperative factor retained to define major surgery (78%). Vascular clampage or organ ischemia (92%), high intraoperative blood loss (90%), high noradrenalin requirements (77%), long operative time (73%) and perioperative blood transfusion (70%) were procedure-related factors that reached consensus. Regarding postoperative factors, systemic inflammatory response (76%) and the need for intensive or intermediate care (88%) reached consensus. Consequences of major surgery were high morbidity (>30% overall) and mortality (>2%). Conclusion: ESA experts defined major surgery according to extent and complexity of the procedure, its pathophysiological consequences and consecutive clinical outcomes.

Published
2020

12. Correction to: Portal Vein Embolization is Associated with Reduced Liver Failure and Mortality in High-Risk Resections for Perihilar Cholangiocarcinoma (Annals of Surgical Oncology, (2020), 10.1245/s10434-020-08258-3)

Author

Olthof P. B., Aldrighetti L., Alikhanov R., Cescon M., Groot Koerkamp B., Jarnagin W. R., Nadalin S., Pratschke J., Schmelzle M., Sparrelid E., Lang H., Guglielmi A., van Gulik T. M., Andreou A., Bartsch F., Benzing C., Buettner S., Capobianco I., de Reuver P., de Savornin Lohman E., Dejong C. H. C., Efanov M., Erdmann J. I., Franken L. C., Frascaroli G., Giglio M. C., Gomez-Gavara C., Heid F., IJzermans J. N. M., Jansson H., Ligthart M. A. P., Maithel S. K., Malago M., Malik H. Z., Muiesan P., Olde Damink S. W. M., Pando E., Quinn L. M., Ratti F., Roberts K. J., Rolinger J., Ruzzenente A., Schadde E., Serenari M., Sultana A., Troisi R., van Laarhoven S., van Vugt J. L. A., Olthof, P. B., Aldrighetti, L., Alikhanov, R., Cescon, M., Groot Koerkamp, B., Jarnagin, W. R., Nadalin, S., Pratschke, J., Schmelzle, M., Sparrelid, E., Lang, H., Guglielmi, A., van Gulik, T. M., Andreou, A., Bartsch, F., Benzing, C., Buettner, S., Capobianco, I., de Reuver, P., de Savornin Lohman, E., Dejong, C. H. C., Efanov, M., Erdmann, J. I., Franken, L. C., Frascaroli, G., Giglio, M. C., Gomez-Gavara, C., Heid, F., Ijzermans, J. N. M., Jansson, H., Ligthart, M. A. P., Maithel, S. K., Malago, M., Malik, H. Z., Muiesan, P., Olde Damink, S. W. M., Pando, E., Quinn, L. M., Ratti, F., Roberts, K. J., Rolinger, J., Ruzzenente, A., Schadde, E., Serenari, M., Sultana, A., Troisi, R., van Laarhoven, S., and van Vugt, J. L. A.

Abstract

In the original article Moritz Schmelzle’s last name is spelled wrong. It is correct as reflected here.

Published
2020

13. Portal Vein Embolization is Associated with Reduced Liver Failure and Mortality in High-Risk Resections for Perihilar Cholangiocarcinoma

Author

Olthof, P. B., Aldrighetti, L., Alikhanov, R., Cescon, M., Groot Koerkamp, B., Jarnagin, W. R., Nadalin, S., Pratschke, J., Schmelze, M., Sparrelid, E., Lang, H., Guglielmi, A., van Gulik, T. M., Andreou, A., Bartsch, F., Benzing, C., Buettner, S., Capobianco, I., de Reuver, P., de Savornin Lohman, E., Dejong, C. H. C., Efanov, M., Erdmann, J. I., Franken, L. C., Frascaroli, G., Giglio, M. C., Gomez-Gavara, C., Heid, F., IJzermans, J. N. M., Jansson, H., Ligthart, M. A. P., Maithel, S. K., Malago, M., Malik, H. Z., Muiesan, P., Olde Damink, S. W. M., Pando, E., Quinn, L. M., Ratti, F., Roberts, K. J., Rolinger, J., Ruzzenente, A., Schadde, E., Serenari, M., Sultana, A., Troisi, R., van Laarhoven, S., van Vugt, J. L. A., Surgery, Academic Medical Center, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Olthof, P. B., Aldrighetti, L., Alikhanov, R., Cescon, M., Groot Koerkamp, B., Jarnagin, W. R., Nadalin, S., Pratschke, J., Schmelze, M., Sparrelid, E., Lang, H., Guglielmi, A., van Gulik, T. M., Andreou, A., Bartsch, F., Benzing, C., Buettner, S., Capobianco, I., de Reuver, P., de Savornin Lohman, E., Dejong, C. H. C., Efanov, M., Erdmann, J. I., Franken, L. C., Frascaroli, G., Giglio, M. C., Gomez-Gavara, C., Heid, F., Ijzermans, J. N. M., Jansson, H., Ligthart, M. A. P., Maithel, S. K., Malago, M., Malik, H. Z., Muiesan, P., Olde Damink, S. W. M., Pando, E., Quinn, L. M., Ratti, F., Roberts, K. J., Rolinger, J., Ruzzenente, A., Schadde, E., Serenari, M., Sultana, A., Troisi, R., van Laarhoven, S., and van Vugt, J. L. A.

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, education, 030230 surgery, Preoperative care, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 03 medical and health sciences, 0302 clinical medicine, Retrospective Studie, Preoperative Care, medicine, Hepatectomy, Humans, Embolization, Abscess, Bile Duct Neoplasm, Aged, Retrospective Studies, portal vein embolization, portal vein embolisation, Perihilar cholangiocarcinoma, Portal Vein, business.industry, Incidence (epidemiology), Liver Neoplasms, Correction, Retrospective cohort study, Middle Aged, Jaundice, medicine.disease, Embolization, Therapeutic, Surgery, Bile Duct Neoplasms, Oncology, Liver Neoplasm, Hepatobiliary Tumors, 030220 oncology & carcinogenesis, Propensity score matching, Cohort, medicine.symptom, business, Liver Failure, Human, Klatskin Tumor
Abstract

Background Preoperative portal vein embolization (PVE) is frequently used to improve future liver remnant volume (FLRV) and to reduce the risk of liver failure after major liver resection. Objective This paper aimed to assess postoperative outcomes after PVE and resection for suspected perihilar cholangiocarcinoma (PHC) in an international, multicentric cohort. Methods Patients undergoing resection for suspected PHC across 20 centers worldwide, from the year 2000, were included. Liver failure, biliary leakage, and hemorrhage were classified according to the respective International Study Group of Liver Surgery criteria. Using propensity scoring, two equal cohorts were generated using matching parameters, i.e. age, sex, American Society of Anesthesiologists classification, jaundice, type of biliary drainage, baseline FLRV, resection type, and portal vein resection. Results A total of 1667 patients were treated for suspected PHC during the study period. In 298 patients who underwent preoperative PVE, the overall incidence of liver failure and 90-day mortality was 27% and 18%, respectively, as opposed to 14% and 12%, respectively, in patients without PVE (p p = 0.005). After propensity score matching, 98 patients were enrolled in each cohort, resulting in similar baseline and operative characteristics. Liver failure was lower in the PVE group (8% vs. 36%, p p p = 0.01), and 90-day mortality (7% vs. 18%, p = 0.03). Conclusion PVE before major liver resection for PHC is associated with a lower incidence of liver failure, biliary leakage, abscess formation, and mortality. These results demonstrate the importance of PVE as an integral component in the surgical treatment of PHC.

Published
2020

14. Comparing practice and outcome of laparoscopic liver resection between high-volume expert centres and nationwide low-to-medium volume centres

Author

Görgec, B, primary, Fichtinger, R S, additional, Ratti, F, additional, Aghayan, D, additional, Van der Poel, M J, additional, Al-Jarrah, R, additional, Armstrong, T, additional, Cipriani, F, additional, Fretland, Å A, additional, Suhool, A, additional, Bemelmans, M, additional, Bosscha, K, additional, Braat, A E, additional, De Boer, M T, additional, Dejong, C H C, additional, Doornebosch, P G, additional, Draaisma, W A, additional, Gerhards, M F, additional, Gobardhan, P D, additional, Hagendoorn, J, additional, Kazemier, G, additional, Klaase, J, additional, Leclercq, W K G, additional, Liem, M S, additional, Lips, D J, additional, Marsman, H A, additional, Mieog, J S D, additional, Molenaar, Q I, additional, Nieuwenhuijs, V B, additional, Nota, C L, additional, Patijn, G A, additional, Rijken, A M, additional, Slooter, G D, additional, Stommel, M W J, additional, Swijnenburg, R J, additional, Tanis, P J, additional, Te Riele, W W, additional, Terkivatan, T, additional, Van den Tol, P M P, additional, Van den Boezem, P B, additional, Van der Hoeven, J A, additional, Vermaas, M, additional, Edwin, B, additional, Aldrighetti, L A, additional, Van Dam, R M, additional, Abu Hilal, M, additional, and Besselink, M G, additional

Published
2021
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19. Small bowel obstruction, incisional hernia and survival after laparoscopic and open colonic resection (LAFA study)

Author

Bartels, S. A. L., Vlug, M. S., Hollmann, M. W., Dijkgraaf, M. G. W., Ubbink, D. T., Cense, H. A., van Wagensveld, B. A., Engel, A. F., Gerhards, M. F., Bemelman, W. A., Cuesta, M. A., van Geloven, A. A. W., van der Zaag, E. S., Wind, J., Preckel, B., Bossuyt, P., Gouma, D., Sprangers, M., van Berge Henegouwen, M. I., Tanis, P. J., Buskens, C. J., van Lenthe, Picard I., Bakker, C., DeJong, C. H., van Dam, R. M., van der Peet, D., van Zalingen, E., Noordhuis, A., Goei, T. H., van Tets, W., deWit, L., Clevers, W., Bieleman, A., Coenen, L., Bonekamp, E., van Abeelen, J., van Iterson-de Jong, D., and Krombeen, M.

Published
2014
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33. Surgery for multiple endocrine neoplasia type 1-related insulinoma: long-term outcomes in a large international cohort

Author

Beek, D J, primary, Nell, S, additional, Verkooijen, H M, additional, Borel Rinkes, I H M, additional, Valk, G D, additional, Vriens, M R, additional, Goudet, P, additional, Vella, A, additional, Donegan, D, additional, Bartsch, D K, additional, Manoharan, J, additional, Perrier, N D, additional, Christakis, I, additional, Brandi, M L, additional, Zarnegar, R, additional, Postma, E L, additional, Kebebew, E, additional, Nockel, P, additional, Brunaud, L, additional, Pasternak, J D, additional, Kluijfhout, W P, additional, Sturgeon, C, additional, Giri, S, additional, Bonsing, B A, additional, Eijck, C H, additional, Goor, H, additional, Kleine, R H J, additional, Dijkum, E J Nieveen, additional, and Dejong, C H C, additional

Published
2020
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34. Volume–outcome relationship of liver surgery: a nationwide analysis

Author

Olthof, P B, primary, Elfrink, A K E, additional, Marra, E, additional, Belt, E J T, additional, van den Boezem, P B, additional, Bosscha, K, additional, Consten, E C J, additional, den Dulk, M, additional, Gobardhan, P D, additional, Hagendoorn, J, additional, van Heek, T N T, additional, IJzermans, J N M, additional, Klaase, J M, additional, Kuhlmann, K F D, additional, Leclercq, W K G, additional, Liem, M S L, additional, Manusama, E R, additional, Marsman, H A, additional, Mieog, J S D, additional, Oosterling, S J, additional, Patijn, G A, additional, te Riele, W, additional, Swijnenburg, R-J, additional, Torrenga, H, additional, van Duijvendijk, P, additional, Vermaas, M, additional, Kok, N F M, additional, Grünhagen, D J, additional, Besselink, M G H, additional, de Boer, M T, additional, Buis, C I, additional, van Gulik, T M, additional, Hoogwater, F J H, additional, Molenaar, I Q, additional, Dejong, C H C, additional, and Verhoef, C, additional

Published
2020
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45. Het Gastro-enterologie Formularium

Author

Mathus-Vliegen, E. M. H., primary, Muris, J. W. M., additional, Numans, M. E., additional, Starmans, R., additional, van Berkestijn, L. G. M., additional, Dejong, C. H. C., additional, van Erpecum, K. J., additional, Felt-Bersma, R. J. F., additional, van der Horst, H. E., additional, Hurenkamp, G. J. B., additional, Kleibeuker, J. H., additional, Klinkenberg-Knol, E. C., additional, Krebber, F. W. A., additional, Kuipers, E. J., additional, Lamers, C. B. H. W., additional, Loffeld, R. J. L. R., additional, Meijer, J. S., additional, van Pinxteren, B., additional, van de Poll, M. C. G., additional, Quartero, A. O., additional, Scholten, P., additional, Smout, A. J. P. M., additional, Soeters, P. B., additional, and De Wit, N. J., additional

Published
2004
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48. Costs and quality of life in a randomized trial comparing minimally invasive and open distal pancreatectomy (LEOPARD trial)

Author

van Hilst, J., Strating, E. A., de Rooij, T., Daams, F., Festen, S., Groot Koerkamp, B., Klaase, J. M., Luyer, M., Dijkgraaf, M. G., Besselink, M. G., van Santvoort, H. C., de Boer, M. T., Boerma, D., van den Boezem, P. B., van Dam, R. M., Dejong, C. H., van Duyn, E. B., van Eijck, C. H., Gerhards, M. F., de Hingh, I. H., Kazemier, G., de Kleine, R. H., van Laarhoven, C. J., Patijn, G. A., Steenvoorde, P., Suker, M., Hilal, M. Abu, RS: NUTRIM - R2 - Liver and digestive health, MUMC+: MA Heelkunde (9), Surgery, Groningen Institute for Organ Transplantation (GIOT), Value, Affordability and Sustainability (VALUE), AGEM - Re-generation and cancer of the digestive system, CCA - Cancer Treatment and quality of life, Epidemiology and Data Science, APH - Methodology, AGEM - Digestive immunity, and CCA - Cancer Treatment and Quality of Life

Subjects
Male, Cost effectiveness, SURGERY, Cost-Benefit Analysis, INTERNATIONAL STUDY-GROUP, OPEN ILEOCOLIC RESECTION, law.invention, BODY-IMAGE, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], Postoperative Complications, 0302 clinical medicine, Robotic Surgical Procedures, Quality of life, Randomized controlled trial, law, Hospital Costs/statistics & numerical data, Outcome Assessment, Health Care, 80 and over, Single-Blind Method, Hospital Costs, Laparoscopy, Netherlands, Aged, 80 and over, medicine.diagnostic_test, Middle Aged, Multicenter Study, Patient Satisfaction, 030220 oncology & carcinogenesis, Randomized Controlled Trial, Original Article, 030211 gastroenterology & hepatology, Female, Quality-Adjusted Life Years, Adult, medicine.medical_specialty, Pancreatectomy/economics, COSMESIS, 03 medical and health sciences, Outcome Assessment (Health Care), All institutes and research themes of the Radboud University Medical Center, Pancreatectomy, Patient satisfaction, medicine, Journal Article, Humans, Comparative Study, Aged, Laparoscopy/economics, business.industry, Cosmesis, Original Articles, Recovery of Function, Confidence interval, Surgery, Quality-adjusted life year, Postoperative Complications/economics, DEFINITION, Quality of Life, Robotic Surgical Procedures/economics, business, Follow-Up Studies
Abstract

Background Minimally invasive distal pancreatectomy decreases time to functional recovery compared with open distal pancreatectomy, but the cost-effectiveness and impact on disease-specific quality of life have yet to be established. Methods The LEOPARD trial randomized patients to minimally invasive (robot-assisted or laparoscopic) or open distal pancreatectomy in 14 Dutch centres between April 2015 and March 2017. Use of hospital healthcare resources, complications and disease-specific quality of life were recorded up to 1 year after surgery. Unit costs of hospital healthcare resources were determined, and cost-effectiveness and cost–utility analyses were performed. Primary outcomes were the costs per day earlier functional recovery and per quality-adjusted life-year. Results All 104 patients who had a distal pancreatectomy (48 minimally invasive and 56 open) in the trial were included in this study. Patients who underwent a robot-assisted procedure were excluded from the cost analysis. Total medical costs were comparable after laparoscopic and open distal pancreatectomy (mean difference €–427 (95 per cent bias-corrected and accelerated confidence interval €–4700 to 3613; P = 0·839). Laparoscopic distal pancreatectomy was shown to have a probability of at least 0·566 of being more cost-effective than the open approach at a willingness-to-pay threshold of €0 per day of earlier recovery, and a probability of 0·676 per additional quality-adjusted life-year at a willingness-to-pay threshold of €80 000. There were no significant differences in cosmetic satisfaction scores (median 9 (i.q.r. 5·75–10) versus 7 (4–8·75); P = 0·056) and disease-specific quality of life after minimally invasive (laparoscopic and robot-assisted procedures) versus open distal pancreatectomy. Conclusion Laparoscopic distal pancreatectomy was at least as cost-effective as open distal pancreatectomy in terms of time to functional recovery and quality-adjusted life-years. Cosmesis and quality of life were similar in the two groups 1 year after surgery.

Published
2019

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