Background

Minimally invasive pancreas resection (MIPR) has been expanding in the past decade. Excellent outcomes have been reported, however, safety concerns exist. The aim of this study was to define prerequisites for performing MIPR with the objective to guide safe implementation of MIPR into clinical practice.

Methods

This systematic review was conducted as part of the 2019 Miami International Evidence-Based Guidelines on Minimally Invasive Pancreas Resection (IG-MIPR). PubMed, Embase and Cochrane databases were searched for literature concerning the implementation of MIPR between 1946 and November 2018. Quality assessment was according to The Scottish Intercollegiate Guidelines Network (SIGN).

Results

Overall, 1150 studies were screened, of which 32 studies with 8519 patients were included in this systematic review. Training programs for minimally invasive distal pancreatectomy, laparoscopic pancreatoduodenectomy and robotic pancreatoduodenectomy have been described with acceptable outcomes during the learning curve and improved outcomes after training. Learning curve studies have revealed an association between growing experience and improving perioperative outcomes. In addition, the association between higher center volume and lower mortality and morbidity has been reported by several studies.

Conclusion

When embarking on MIPR, it is recommended to participate in a dedicated training program, to assure a sufficient volume, especially when implementing minimally invasive pancreatoduodenectomy, (20 procedures recommended annually), and prospectively collect and closely monitor outcomes for continuous quality assessment, this can be achieved through institutional databases and participation in national or international registries.

中文翻译：

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安全实施微创胰腺切除术：系统评价。

背景

在过去的十年中，微创胰腺切除术 (MIPR) 一直在扩大。已经报道了出色的结果，但是，存在安全问题。本研究的目的是确定实施 MIPR 的先决条件，以指导在临床实践中安全实施 MIPR。

方法

该系统评价是作为 2019 年迈阿密国际微创胰腺切除循证指南 (IG-MIPR) 的一部分进行的。在 PubMed、Embase 和 Cochrane 数据库中搜索了有关 1946 年至 2018 年 11 月期间实施 MIPR 的文献。质量评估是根据苏格兰校际指南网络 (SIGN) 进行的。

结果

总体而言，筛选了 1150 项研究，其中包含 8519 名患者的 32 项研究被纳入本系统评价。微创胰远端切除术、腹腔镜胰十二指肠切除术和机器人胰十二指肠切除术的培训计划在学习曲线期间具有可接受的结果，培训后的结果有所改善。学习曲线研究揭示了成长经验与改善围手术期结果之间的关联。此外，一些研究报告了较高的中心容量与较低的死亡率和发病率之间的关联。

结论

在开始 MIPR 时，建议参加专门的培训计划，以确保足够的训练量，尤其是在实施微创胰十二指肠切除术时（每年推荐 20 次手术），并前瞻性地收集和密切监测结果以进行持续的质量评估，这可以通过机构数据库和参与国家或国际登记处来实现。