Prospective minimally invasive pancreatic resections from the IGOMIPS registry: a snapshot of daily practice in Italy on 1191 between 2019 and 2022
Authors: Boggi Ugo , Donisi Greta , Napoli Niccolò , Partelli Stefano , Esposito Alessandro , Ferrari Giovanni , Butturini Giovanni , Morelli Luca , Abu Hilal Mohammad , Viola Massimo , Di Benedetto Fabrizio , Troisi Roberto , Vivarelli Marco , Jovine Elio , Ferrero Alessandro , Bracale Umberto , Alfieri Sergio , Casadei Riccardo , Ercolani Giorgio , Moraldi Luca , Molino Carlo , Dalla Valle Raffaele , Ettorre Giuseppe , Memeo Riccardo , Zanus Giacomo , Belli Andrea , Gruttadauria Salvatore , Brolese Alberto , Coratti Andrea , Garulli Gianluca , Romagnoli Renato , Massani Marco , Borghi Felice , Belli Giulio , Coppola Roberto , Falconi Massimo , Salvia Roberto , Zerbi Alessandro ,   the IGOMPIS registry, Kauffmann Emanuele F. , Capretti Giovanni , Genova Luana , Pastena Matteo De , Mazzola Michele , Giardino Alessandro , Palmieri Matteo , Manzoni Alberto , Barbieri Vittoria , Ballarin Roberto , Rompianesi Gianluca , Rossi Roberta , Mastrangelo Laura , Langella Serena , Ilardi Mariangela , Menghi Roberta , Ricci Claudio , Gardini Andrea , Campra Donata , Crolla Enrico , Cecconi Sara , Meniconi Roberto L. , Ferraro Valentina , Brizzolari Marco , Izzo Francesco , Cintorino Davide , Marcucci Stefano , Giuliani Giuseppe , Veneroni Luigi , Moro Francesco , Nistri Cristina , Caputo Damiano , Gianluca Baiocchi , Mazzaferro Vincenzo 
Published: July 2023

This retrospective analysis of the prospective IGOMIPS registry reports on 1191 minimally invasive pancreatic resections (MIPR) performed in Italy between 2019 and 2022, including 668 distal pancreatectomies (DP) (55.7%), 435 pancreatoduodenectomies (PD) (36.3%), 44 total pancreatectomies (3.7%), 36 tumor enucleations (3.0%), and 8 central pancreatectomies (0.7%). Spleen-preserving DP was performed in 109 patients (16.3%). Overall incidence of severe complications (Clavien–Dindo ≥ 3) was 17.6% with a 90-day mortality of 1.9%. This registry analysis provided some important information. First, robotic assistance was preferred for all MIPR but DP with splenectomy. Second, robotic assistance reduced conversion to open surgery and blood loss in comparison to laparoscopy. Robotic PD was also associated with lower incidence of severe postoperative complications and a trend toward lower mortality. Fourth, the annual cut-off of ≥ 20 MIPR and ≥ 20 MIPD improved selected outcome measures. Fifth, most MIPR were performed by a single surgeon. Sixth, only two-thirds of the centers performed spleen-preserving DP. Seventh, DP with splenectomy was associated with higher conversion rate when compared to spleen-preserving DP. Eighth, the use of pancreatojejunostomy was the prevalent reconstruction in PD. Ninth, final histology was similar for MIPR performed at high- and low-volume centers, but neoadjuvant chemotherapy was used more frequently at high-volume centers. Finally, this registry analysis raises important concerns about the reliability of R1 assessment underscoring the importance of standardized pathology of pancreatic specimens. In conclusion, MIPR can be safely implemented on a national scale. Further analyses are required to understand nuances of implementation of MIPR in Italy.