Defining Benchmark Outcomes for Distal Pancreatectomy: Results of a French Multicentric Study.

Thibault Durin (1) , Ugo Marchese (2) , Alain Sauvanet (3) , Safi Dokmak (4) , Zineb Cherkaoui (5, 6) , David Fuks (7) , Christophe Laurent (8) , Marie André (9, 10, 11) , Ahmet Ayav (12, 13) , Cloe Magallon (14) , Olivier Turrini (15, 2) , Laurent Sulpice (16, 17) , Fabien Robin (16, 17) , Philippe Bachellier (6) , Piettro Addeo , François-Régis Souche (18) , Thomas Bardol (19, 18) , Julie Perinel (20) , Mustapha Adham (21) , Stylianos Tzedakis (17) , David Jérémie Birnbaum (22) , Olivier Facy (23) , Johan Gagniere (24, 25) , Sébastien Gaujoux (26) , Ecoline Tribillon , Edouard Roussel (27) , Lilian Schwarz (28, 29) , Louise Barbier (30) , Alexandre Doussot (31) , Nicolas Regenet (32) , Antonio Iannelli (33, 34) , Jean-Marc Regimbeau (35, 36) , Guillaume Piessen (1) , Xavier Lenne (1) , Stéphanie Truant (1) , Mehdi El Amrani (1)

1 CHRU Lille - Centre Hospitalier Régional Universitaire [Lille]
2 Institut Paoli-Calmettes
3 Service de chirurgie hepato-pancreato-biliaire
4 Hôpital Beaujon [AP-HP]
5 IVH - Institut de Recherche sur les Maladies Virales et Hépatiques
6 CHU Strasbourg
7 UPCité - Université Paris Cité
8 CHU Bordeaux [Bordeaux]
9 OENO - Unité de Recherche Œnologie [Villenave d'Ornon]
10 ISVV - Institut des Sciences de la Vigne et du Vin [Villenave d'Ornon]
11 MHCS - Moët Hennessy Champagne Services
12 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
13 Faculté de Médecine [Nancy]
14 AMU SMPM MED - Aix-Marseille Université - École de médecine
15 CRCM - Centre de Recherche en Cancérologie de Marseille
16 OSS - Oncogenesis, Stress, Signaling
17 CHU Pontchaillou [Rennes]
18 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
19 Département d'Hépato-Gastroentérologie et de Transplantation Hépatique [CHU Saint-Eloi]
20 CHB - Centre hépato-biliaire
21 Hôpital de la Croix-Rousse [CHU - HCL]
22 APHM - Assistance Publique - Hôpitaux de Marseille
23 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
24 CIC 1405 - Centre d'Investigation Clinique [CHU Clermont-Ferrand]
25 M2iSH - Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte
26 Service de Chirurgie Digestive, Hépato-Bilio-pancréatique et Transplantation Hépatique [CHU Pitié-Salpétrière]
27 Hôpital Charles Nicolle [Rouen]
28 Service de chirurgie digestive [CHU Rouen]
29 GPMCND - Génomique et Médecine Personnalisée du Cancer et des Maladies Neuropsychiatriques
30 CHU Trousseau [Tours]
31 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
32 CHU Nantes - Centre hospitalier universitaire de Nantes
33 C3M - Centre méditerranéen de médecine moléculaire
34 Hôpital l'Archet
35 Chirurgie digestive [CHU Amiens]
36 SSPC - Simplification des soins chez les patients complexes - UR UPJV 7518

OBJECTIVE: Defining robust and standardized outcome references for distal pancreatectomy (DP) by using Benchmark analysis. BACKGROUND: Outcomes after DP are recorded in medium or small-sized studies without standardized analysis. Therefore, the best results remain uncertain. METHODS: This multicenter study included all patients undergoing DP for resectable benign or malignant tumors in 21 French expert centers in pancreas surgery from 2014 to 2018. A low-risk cohort defined by no significant comorbidities was analyzed to establish 18 outcome benchmarks for DP. These values were tested in high-risk, minimally invasive and benign tumor cohorts. RESULTS: 1188 patients were identified and 749 low-risk patients were screened to establish Benchmark cut-offs. Therefore, Benchmark rate for mini-invasive approach was ≥q36.8%. Benchmark cut-offs for postoperative mortality, major morbidity grade ≥q3a and clinically significant pancreatic fistula rates were 0%, ≤q27% and ≤q28%, respectively. The benchmark rate for readmission was ≤q 16%. For patients with pancreatic adenocarcinoma, cut-offs were ≥q75%, ≥q69.5% and ≥q66% for free resection margins (R0), 1-year disease free-survival and 3-year overall survival, respectively. The rate of mini-invasive approach in high-risk cohort was lower than the Benchmark cut-off (34.1% vs. ≥q36.8%). All Benchmark cut-offs were respected for benign tumor group. The proportion of benchmark cases was correlated to outcomes of DP. Centers with a majority of low-risk patients had worse results than those operating complex cases. CONCLUSION: This large-scale study is the first benchmark analysis of DP outcomes and provides robust and standardized data. This may allow for comparisons between surgeons, centers, studies, and surgical techniques.

Domaines: Médecine humaine et pathologie

Thibault Durin, Ugo Marchese, Alain Sauvanet, Safi Dokmak, Zineb Cherkaoui, et al.. Defining Benchmark Outcomes for Distal Pancreatectomy: Results of a French Multicentric Study.. Annals of Surgery, 2022, Publish Ahead of Print, ⟨10.1097/SLA.0000000000005539⟩. ⟨hal-03711172⟩