Improving outcomes in minimally invasive pancreatoduodenectomy

This thesis investigates various aspects of minimally invasive pancreatoduodenectomy (MIPD), focusing on its implementation, clinical outcomes, and comparative effectiveness within the Netherlands and across Europe. It highlights the ongoing shift from laparoscopic pancreatoduodenectomy (LPD) to robotic-assisted pancreatoduodenectomy (RPD), supported by data from both national and international registries. The European registry for Minimally Invasive Pancreatic Surgery (E-MIPS) and the randomized controlled DIPLOMA-2 trial form the backbone of this work. The DIPLOMA-2 trial, a multicenter randomized controlled study, demonstrates that MIPD is non-inferior to open pancreatoduodenectomy (OPD) in terms of postoperative complication rates and provides superior outcomes in time to functional recovery.
Further analyses confirm that MIPD is both feasible and safe across a broad range of patient populations, including elderly patients, with comparable mortality outcomes to those following OPD. However, inter-institutional variation in outcomes remains. Additionally, the thesis addresses postoperative risk stratification by evaluating fistula risk scores specific to RPD, aiming to enhance perioperative planning and optimize patient selection.
Collectively, the findings of this thesis support the safe and evidence-based expansion of MIPD. They underscore the importance of ongoing evaluation through randomized controlled trials and high-quality clinical registries to ensure standardized, safe, and effective surgical practice.