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      International consensus guidelines on robotic pancreatic surgery in 2023

      review-article
      1 , , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 1 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 1 , 1 , 1 , 1 , 1 , 1 , 1 , 2 , 4 , 5
      Hepatobiliary Surgery and Nutrition
      AME Publishing Company
      Robotic surgery, guidelines, pancreatectomy, pancreaticoduodenectomy, distal pancreatectomy (DP)

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          Abstract

          Background

          With the rapid development of robotic surgery, especially for the abdominal surgery, robotic pancreatic surgery (RPS) has been applied increasingly around the world. However, evidence-based guidelines regarding its application, safety, and efficacy are still lacking. To harvest robust evidence and comprehensive clinical practice, this study aims to develop international guidelines on the use of RPS.

          Methods

          World Health Organization (WHO) Handbook for Guideline Development, GRADE Grid method, Delphi vote, and the AGREE-II instrument were used to establish the Guideline Steering Group, Guideline Development Group, and Guideline Secretary Group, formulate 19 clinical questions, develop the recommendations, and draft the guidelines. Three online meetings were held on 04/12/2020, 30/11/2021, and 25/01/2022 to vote on the recommendations and get advice and suggestions from all involved experts. All the experts focusing on minimally invasive surgery from America, Europe and Oceania made great contributions to this consensus guideline.

          Results

          After a systematic literature review 176 studies were included, 19 questions were addressed and 14 recommendations were developed through the expert assessment and comprehensive judgment of the quality and credibility of the evidence.

          Conclusions

          The international RPS guidelines can guide current practice for surgeons, patients, medical societies, hospital administrators, and related social communities. Further randomized trials are required to determine the added value of RPS as compared to open and laparoscopic surgery.

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          Most cited references146

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          Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial.

          Laparoscopic-assisted surgery for colorectal cancer has been widely adopted without data from large-scale randomised trials to support its use. We compared short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer to predict long-term outcomes. Between July, 1996, and July, 2002, we undertook a multicentre, randomised clinical trial in 794 patients with colorectal cancer from 27 UK centres. Patients were allocated to receive laparoscopic-assisted (n=526) or open surgery (n=268). Primary short-term endpoints were positivity rates of circumferential and longitudinal resection margins, proportion of Dukes' C2 tumours, and in-hospital mortality. Analysis was by intention to treat. This trial has been assigned the International Standard Randomised Controlled Trial Number ISRCTN74883561. Six patients (two [open], four [laparoscopic]) had no surgery, and 23 had missing surgical data (nine, 14). 253 and 484 patients actually received open and laparoscopic-assisted treatment, respectively. 143 (29%) patients underwent conversion from laparoscopic to open surgery. Proportion of Dukes' C2 tumours did not differ between treatments (18 [7%] patients, open vs 34 [6%], laparoscopic; difference -0.3%, 95% CI -3.9 to 3.4%, p=0.89), and neither did in-hospital mortality (13 [5%] vs 21 [4%]; -0.9%, -3.9 to 2.2%, p=0.57). Apart from patients undergoing laparoscopic anterior resection for rectal cancer, rates of positive resection margins were similar between treatment groups. Patients with converted treatment had raised complication rates. Laparoscopic-assisted surgery for cancer of the colon is as effective as open surgery in the short term and is likely to produce similar long-term outcomes. However, impaired short-term outcomes after laparoscopic-assisted anterior resection for cancer of the rectum do not yet justify its routine use.
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            Oncological Benefits of Neoadjuvant Chemoradiation With Gemcitabine Versus Upfront Surgery in Patients With Borderline Resectable Pancreatic Cancer

            This study was performed to determine whether neoadjuvant treatment increases survival in patients with BRPC.
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              Minimally Invasive Versus Open Distal Pancreatectomy (LEOPARD)

              This trial followed a structured nationwide training program in minimally invasive distal pancreatectomy (MIDP), according to the IDEAL framework for surgical innovation, and aimed to compare time to functional recovery after minimally invasive and open distal pancreatectomy (ODP).
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                Author and article information

                Journal
                Hepatobiliary Surg Nutr
                Hepatobiliary Surg Nutr
                HBSN
                Hepatobiliary Surgery and Nutrition
                AME Publishing Company
                2304-3881
                2304-389X
                18 January 2024
                01 February 2024
                : 13
                : 1
                : 89-104
                Affiliations
                [1 ]deptFaculty of Hepatopancreatobiliary Surgery , The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital , Beijing, China;
                [2 ]deptDepartment of Surgery , Poliambulanza Foundation Hospital , Brescia, Italy;
                [3 ]deptDepartment of Surgery , University Hospital Southampton NHS Foundation Trust , Southampton, UK;
                [4 ]Amsterdam UMC, location University of Amsterdam , deptDepartment of Surgery , Amsterdam, The Netherlands;
                [5 ]Cancer Center Amsterdam , Amsterdam, The Netherlands;
                [6 ]deptDepartment of General, Visceral and Thoracic Surgery , University Hospital Hamburg-Eppendorf , Hamburg, Germany;
                [7 ]deptDepartment of Minimal Invasive Hernia Surgery , GEM Hospital and Research Centre , Chennai, Tamil Nadu, India;
                [8 ]deptDepartment of General Surgery , Peking Union Medical College Hospital Beijing , Beijing, China;
                [9 ]deptDepartment of Surgery , Johns Hopkins University School of Medicine , Baltimore, MD, USA;
                [10 ]deptDivision of General and Transplant Surgery , University of Pisa , Pisa, Italy;
                [11 ]deptDepartment of Surgery, Seoul National University Hospital , Seoul National University College of Medicine , Seoul, Korea;
                [12 ]deptDepartment of Surgery/Division of HBP Surgery & Transplantation , University of Montpellier , Montpellier, France;
                [13 ]deptDepartment of Hepatopancreatobiliary and Transplant Surgery , Singapore General Hospital and National Cancer Centre Singapore , Singapore;
                [14 ]deptDepartment of Hepato-Pancreato-Biliary Surgery , Moscow Clinical Scientific Center , Moscow, Russia;
                [15 ]Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Shinjuku , Tokyo, Japan;
                [16 ]deptDepartment of Surgery , Yeungnam University College of Medicine , Daegu, Korea;
                [17 ]deptDepartment of Pancreato-Biliary Surgery , The First Affiliated Hospital of Sun Yat-sen University , Guangzhou, China;
                [18 ]deptDivision of General Surgery, Department of Surgery , Taipei Veterans General Hospital , Taipei;
                [19 ]deptDivision of Hepatobiliary, Pancreatic Surgery and Liver Transplantation , National University Hospital , Singapore, Singapore;
                [20 ]deptDepartment of Surgery , Galilee Medical Center , Nahariya, Israel;
                [21 ]Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si , Korea;
                [22 ]deptDivision of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center , University of Ulsan College of Medicine , Seoul, Korea;
                [23 ]deptDepartment of General-, Vascular-, Visceral- and Transplant Surgery , University Hospital Magdeburg , Magdeburg, Germany;
                [24 ]deptDivision of General Surgery, Department of Surgery , Taipei Veterans General Hospital , Taipei;
                [25 ]General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello , Palermo, Italy;
                [26 ]Department of General and Minimal Access Surgery and Robotic Surgery, Indraprastha Apollo Hospitals , New Delhi, India;
                [27 ]deptDepartment of Pancreatic Surgery , Fudan University Shanghai Cancer Center , Shanghai, China;
                [28 ]deptDivision of Hepatobiliary Surgery , The First Affiliated Hospital of Guangxi Medical University , Nanning, China;
                [29 ]deptEvidenceBased Medicine Center, School of Basic Medical Sciences , Lanzhou University , Lanzhou, China
                Author notes

                Contributions: (I) Conception and design: R Liu; (II) Administrative support: R Liu, MA Hilal, MG Besselink, T Hackert, C Palanivelu, Y Zhao; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: Q Liu, Z Wang, M Li, S Xu, K Wei, Z Deng, Y Jia, K Yang; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

                Correspondence to: Rong Liu, MD, PhD. Clinical Professor, Director of Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, 28 Fuxing Road, Beijing 100853, China. Email: Liurong301@ 123456126.com .
                Article
                hbsn-13-01-89
                10.21037/hbsn-23-132
                10839730
                38322212
                a4fb25f3-97b5-4d52-97c9-c21b9dd563d2
                2024 Hepatobiliary Surgery and Nutrition. All rights reserved.

                Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

                History
                : 15 March 2023
                : 10 November 2023
                Categories
                Expert Consensus

                robotic surgery,guidelines,pancreatectomy,pancreaticoduodenectomy,distal pancreatectomy (dp)

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