This study of patients undergoing hepatopancreaticobiliary surgery reports significant variability in hospital costs associated with patient and hospital characteristics.
This retrospective cohort study finds that pancreatic resection with autologous islet transplantation for severe chronic pancreatitis is a safe and effective final alternative to ameliorate debilitating pain and to help prevent the development of surgical diabetes.
This study reports that rigorous risk-adjusted surgical quality assessment can be performed solely with objective variables. By leveraging data already routinely collected for patient care, this approach allows for wider adoption of quality assessment systems in health care.
Krell et al determine the reliability of risk-adjusted morbidity and mortality for hospital performance profiling using clinical registry data from the American College of Surgeons National Surgical Quality Improvement Program. See also the invited commentary by Rhoads and Wren.
Robotic-assisted pancreatic resection and reconstruction are safe and can reproduce perioperative results seen in open surgery.
Single-institution retrospective review.
Tertiary care center.
Patients undergoing completed robotic-assisted pancreatic resection and reconstruction at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, between October 3, 2008, and February 26, 2010.
Primary pathology, operative time, operative blood loss, perioperative blood transfusions, pancreatic fistula, 90-day morbidity and mortality, and readmission rate.
Thirty patients with a median age of 70 years (range, 32-85 years) underwent completed robotic-assisted pancreatic resection and reconstruction. Procedures were robotic-assisted non-pylorus-preserving pancreaticoduodenectomy (n = 24), robotic-assisted central pancreatectomy (n = 4), and the robotic-assisted Frey procedure (n = 2). The median operative time was 512 minutes (range, 327-848 minutes). The median blood loss was 320 mL (range, 50-1000 mL), with a median length of hospital stay of 9 days (range, 4-87 days). The final diagnoses included periampullary adenocarcinoma (n = 7), pancreatic ductal adenocarcinoma (n = 6), pancreatic neuroendocrine tumor (n = 5), intraductal papillary mucinous neoplasm (n = 4), mucinous cystic neoplasm (n = 3), serous cystic adenoma (n = 2), chronic pancreatitis (n = 2), and solid pseudopapillary neoplasm (n = 1). There was 1 postoperative death. The overall pancreatic fistula rate was 27% (n = 8). The clinically significant pancreatic fistula rate (International Study Group on Pancreatic Fistula grades B and C) was 10% (n = 3). Clavien grade III and IV complications occurred in 7 patients (23%), while Clavien grade I and II complications occurred in 8 patients (27%).
Robotic-assisted complex pancreatic surgery can be performed safely in a high-volume pancreatic tertiary care center with perioperative outcomes comparable to those of open surgery. Advances in robotic technology and increasing experience may improve long operative times.