wetenschapsdag vrijdag 13 oktober Felix Meritis Amsterdam PROGRAMMA- EN ABSTRACTBOEK
2 | wetenschapsdag 2023
wetenschapsdag 2023 | 3 Voorwoord Hartelijk welkom op de 2023 Wetenschapsdag van Regio Amsterdam. Een dag die wederom gevuld zal zijn met innoverend wetenschappelijk werk, inspirerende gedachtewisselingen en verbinding tussen alle leden, jong en oud, van Regio Amsterdam. Dit jaar zal de Wetenschapsdag plaatsvinden in Felix Meritis. Een genootschap dat werd opgericht in 1777 door de gegoede burgerij van Amsterdam. Het hoofddoel van het genootschap was om ‘… door het beoefenen van kunsten en wetenschappen verstand en deugd aan te kweeken, en het gezellig verkeer onder de Leden te bevorderen.’ Nog zeer toepasselijk drie en een halve eeuw later. Gezelligheid, saamhorigheid en vriendschap zijn immers de sleutel voor succes, ongeacht of het een professie of sport betreft. Interessant om te beseffen dat Felix Meritis mede werd opgericht, omdat Amsterdam in de 18e eeuw haar culturele voorhoedepositie aan het verliezen was. De vernieuwing kwam vooral uit Haarlem waar invloedrijke genootschappen en tijdschriften werden opgericht. Dit onderstreept het belang van de regio dan wel het netwerk. En ook dat is aan de orde van de dag. Samenwerken over de grenzen van zorgorganisaties heen is van vitaal belang voor goede en betaalbare zorg. Felix Meritis was tot eind 1800 de belangrijkste muziekzaal van Amsterdam waar onder andere Robert Schumann, Camille Saint-Saëns en Johannes Brahms optraden. Hun namen prijken op de balustrade van de grote zaal van Felix Meritis en vormden de muzikale entourage van de Wetenschapsdag. De Wetenschapsdag 2023 is het resultaat van de enthousiaste inzet van alle leden van de Wetenschapscommissie, die het afgelopen jaar met passie en toewijding een prachtig programma hebben gerealiseerd. Namens Regio Amsterdam onze hartelijke dank! Jaap Bonjer
4 | wetenschapsdag 2023 Welkomstwoord van de commissie Dit jaar heten wij iedereen welkom in het prachtige Felix Meritis voor de regiobrede Wetenschapsdag Chirurgie. Een dag die onze prachtige Regio A weet te verbinden, een dag gewijd aan een afwisselend en inspirerend wetenschappelijk programma en grensverleggend onderzoek vanuit ziekenhuizen uit de hele regio. Een dag waarin de regio bij elkaar komt en nieuwe kennis wordt gedeeld. Laat je inspireren door de meest recente ontwikkelingen in de chirurgie, binnen en buiten uw eigen vakgebied. Ook zijn er vele partners betrokken, welke allen vol enthousiasme hun laatste innovaties met ons willen delen, dus vergeet vooral niet om hier een bezoek te brengen in een van de pauzes. De dag zal plaatsvinden in het Felix Meritis (‘Gelukkig door verdiensten’), voorheen een internationale ontmoetingsplaats voor kunstenaars, wetenschappers en culturele ondernemers. Dit historische en inspirerende gebouw biedt een passende setting voor de Wetenschapsdag Chirurgie. De plenaire sessies zullen dit jaar in het teken staan van ‘Wetenschap & Media’. De rol van media in de medische sector is onmiskenbaar, het biedt een platform voor het delen van medische kennis en innovaties met een wereldwijd publiek. Maar welke verantwoordelijkheden heb je als arts (in de media) en hoe vind je als medisch expert je rol in de huidige en snel veranderende mediadynamiek? We kijken ernaar uit om samen met jullie een inspirerende discussie aan te gaan over dit actuele onderwerp. We kijken enorm uit naar deze inspirerende dag en hopen dat iedereen er enorm van zal genieten. De organisatie Wetenschapsdagcommissie 2023
wetenschapsdag 2023 | 5 Welkomstwoord van de commissie
6 | wetenschapsdag 2023 Organisatie & namen Rutger-Jan Swijnenburg Jaap Bonjer Frank Bloemers David Nijssen Anouck Haanappel Kak Khee Yueng Robin Eelsing Josefien van Olmen Rutger Henrar Anne Gehrels Marjolein van Egmond Adinda Pijpers Liesbeth Munster
wetenschapsdag 2023 | 7 Met dank aan onze sponsoren Met dank aan onze sponsoren
8 | wetenschapsdag 2023 About Gore W. L. Gore & Associates is a global materials science company dedicated to transforming industries and improving lives. Since 1958, Gore has solved complex technical challenges in demanding environments — from outer space to the world’s highest peaks to the inner workings of the human body. With more than 11,000 Associates and a strong, team-oriented culture. For more information, visit gore.com. Medical Products Gore engineers medical devices that treat a range of cardiovascular and other health conditions. With more than 50 million medical devices implanted over the course of more than 45 years, Gore builds on its legacy of improving patient outcomes through research, education and quality initiatives. Product performance, ease of use and quality of service provide sustainable cost savings for physicians, hospitals and insurers. Gore is joined in service with clinicians and through this collaboration we are improving lives. For more information, visit goremedical.com.
wetenschapsdag 2023 | 9 Dagprogramma Dagprogramma Tijd Sessie Locatie Verdieping 08:30-09:00 Inloop Restaurant 0 09:00-09:15 Welkomstwoord Prof. Bonjer Concertzaal 0 09:15-10:00 Openingssessie: Lopend onderzoek in de regio Amsterdam Concertzaal 0 10:00-10:30 Keynote Lecture Diederik Gommers Concertzaal 0 10:30-11:00 Pauze 1: koffiepauze Restaurant Zuilenzaal 0 1 11:00-12:00 Sessie 1a: Viatris: Pantastische Pa ncreas-Perikelen Sessie 1b: Ticks, Checks and Balances Sessie 1c: We Zullen Doorgaan Sessie 1d: Een Goede Fundering Voor de Chirurgische Lering Concertzaal Teekenzaal Shaffyzaal Huslyzaal 0 3 2 5 12:00-13:00 Pauze 2: lunchpauze Restaurant Zuilenzaal 0 1 13:00-13:45 Sessie 2a: Den Nederlanden - en Daar Voorbij Sessie 2b: Classificaties: van Chaos naar Categorie Sessie 2c: Laat Me, opereren! Sessie 2d: Laparos: het Ontwerp Binnenste Binnen Keren Concertzaal Teekenzaal Shaffyzaal Huslyzaal 0 3 2 5 13:45-14:15 Pauze 3: koffiepauze Restaurant Zuilenzaal 0 1 14:15-15:00 Sessie 3a: Holl(t)en of Stilstaan Sessie 3b: Chirurgie voorbij de scalpel Sessie 3c: Zing, Vecht, Huil, Bid, Lach, Werk en Bewonder Sessie 3d: Architecturale Hoogstandjes en Chirurgische Laagstandjes: Een Kijk op Complicaties Concertzaal Teekenzaal Shaffyzaal Huslyzaal 0 3 2 5 15:00 -15:15 Pauze 4: Wisselpauze 15:15-16:00 Panel discussie Concertzaal 0 16:00-16:45 Best abstract sessie Concertzaal 0 16:45 -17:10 Afsluiting en fotomoment Concertzaal 0 17:00-19:30 Borrel Restaurant 0
10 | wetenschapsdag 2023 Regio A 6 1 4 2 2 5 8 9 10 3 7 7
wetenschapsdag 2023 | 11 1 2 4 5 6 8 9 10 7 3
12 | wetenschapsdag 2023 Zalenoverzicht Felix Meritis
wetenschapsdag 2023 | 13 Bridge the gap between innovation and implementation SAS and PW Consulting offer the Healthcare Startup Service to make innovation in the field of data and analytics accessible to hospitals. The Healthcare Startup Service provides a step-by-step approach to help hospitals to get more value from their data and analytics projects and to scale up easily. Our technology and guidance allows the hospital to be at the helm of this innovation. By leveraging their own data and developing their skills and knowledge we ensure that we create valuable and relevant insights. Using a step-by-step approach and a multi-disciplinary team with domain expertise, analytics knowledge and an abundance of enthusiasm, we guide the project towards success and the hospital towards becoming more data-driven. Whether it pertains to providing clinical decision support or addressing capacity challenges, through the ‘Healthcare Startup Service,’ we can clearly illustrate how to implement this comprehensive approach within your hospital. The Healthcare Startup Service Antonie Berkel Account Executive Healthcare SAS Nederland Nienke van Zoggel Business Consultant Healthcare PW Consulting Ready to bring your analytics into clinical practice? Connect with our team!
wetenschapsdag 2023 | 15 Lopend onderzoek in de regio Amsterdam
16 | wetenschapsdag 2023 Lopend onderzoek in de regio Amsterdam Openingssessie 09.15 - 10.00 Concertzaal Voorzitters: Matthijs Nijenhuis Philip d’Ailly 1 A.M. Eskes - Family participation in surgical care 2 A.H.M. Mennen - The PELVIC Study 3 D.J. van de Berg - The Fluopatch Study 4 L. Rijken - The VASCUL-AID Project
wetenschapsdag 2023 | 17 Openingssessie x Auteurs A.M. Eskes Abstract title Family participation in surgical care Background Increasing demand for healthcare has exacerbated the pressures hospitals around the world experience for beds, resulting in patients going home quicker and sicker. The transition from hospital to home can be challenging for both surgical patients and their families, especially when patients require additional support to manage their recovery. Traditionally, community nursing services have provided professional care to support patient recovery after hospital discharge, but it can be questioned if this is sustainable given the existing health service pressures, such as nurses leaving the profession, on the healthcare system. It is a real concern that future health systems will be unable to provide post-hospital surgical care in the way we and patients’ families expect. Families, who can be relatives or close friends with whom patients have significant relationships, may be required to provide care in this new world. To proactively address this, a shift in how we approach (post)-hospital care is needed. A way to do that is for example by implementing a family involvement program. Families were involved and trained in a range of activities including fundamental care, such as mobilization, breathing exercises and active orientation in time, place and person. In a recent study investigating this program in a sample of 302 patients, we found a 17% reduction in the need for professional care at discharge when a family caregiver was involved. More importantly, patients reported a higher satisfaction when family members were part of the care process and no clinical relevant increase in caregiver burden was found. Besides these clinical challenges, another challenge is to retain nurses for clinical care. Therefore, more and more hospitals implement clinical academic nurse positions for nurses with a university degree. This is important for the retention of talented nurses with academic skills and knowledge in clinical practice. 1
18 | wetenschapsdag 2023 x Lopend onderzoek in de regio Amsterdam Auteurs A.H.M. Mennen, M. Lommerse, R. Hemke, H.C. Willems, K.J. Ponsen, M. Maas, F.W. Bloemers, D. van Embden; PELVIC study group Abstract title Impact of regional implementation of a clinical pathway for elderly patients with pelvic fragility fractures (PELVIC) after low energy trauma; a multicentre, stepped-wedge, randomized controlled trial Introduction Patients with pelvic fragility fractures suffer from high morbidity and mortality rates. Despite the high incidence of these injuries, there is currently no regional or nationwide treatment protocol which results in a wide variety of clinical practice. New insights in treatment strategies, such as early diagnosis and minimal invasive operative treatment of these fragile patient population, has led to the development of several clinical pathways in recent literature. The aim of this study is to implement an evidence and experience-based treatment clinical pathway to improve the outcomes in this fragile patient population that currently has multifactorial risks for poor outcome Methods and analysis This study will be a regional stepped-wedge cluster RCT which aims for implementation of a clinical pathway in nine trauma centres in the Netherlands. All elderly patients (≥ 50 years old) who suffered a pelvic fragility fracture after low energetic trauma (LET) and are presented to one of the participating hospitals are eligible for inclusion. The pathway aims to optimise the diagnostic process, guides the decision making process for further treatment (e.g. operative or conservative), structures the follow-up, and provides guidelines on post-operative care, pain management, a physiotherapy protocol, and osteoporosis work-up. Outcome measurements The primary outcome is mobility, measured by the Parker Mobility Score (PMS). Secondary outcomes are mobility measured by the Elderly Mobility Scale (EMS), functional performance, quality of life, return to home rate, level of pain, type and dosage of analgesic medications, number of falls after treatment, number of (fracture related) complications, 1-year and 2-year mortality. Every 6 weeks a cluster will switch from current practice to the clinical pathway. The aim is a total of 393 inclusions, which provides a 80% statistical power for an improvement in mobility of 10%, measured by the Parker mobility score (PMS). 2
wetenschapsdag 2023 | 19 Openingssessie x Auteurs D.J. van de Berg Title Fluorescence Imaging for the Perfusion of the Parathyroid Glands of Children (FLUOPATCH) Background Postoperative hypocalcemia, a severe complication of pediatric thyroid surgery, occurs in 20-67% of the children and leads to a lifelong reduced quality of life and increased morbidity rates. In adults, quantified ICG-fluorescence angiography of the parathyroid glands has shown to reduce postoperative hypocalcemia. However, in children no studies have yet been conducted. The aim of this study is to develop a standardized imaging workflow model for quantified ICG-angiography of the parathyroid glands in children. Methods Study design: A prospective, observational, multicenter, feasibility study. Population: Patients (<18 years of age) undergoing total thyroidectomy for any indication. Duration and participating centers: Participant enrollment will occur over a twelve month period in Amsterdam UMC, UMC Utrecht and UMC Groningen. Intervention: Patients will always receive standard care. For the purpose of this study, the camera set-up (i.e. camera distance to the operating field) and ICG-protocol (i.e. dose, injection speed) will be standardized among the participating centers in order to generate an homogeneous data set for quantification of the fluorescence signal intensity. Primary objective: Primary goal of this study is to create a standardized and user-independent workflow model of quantified ICG-angiography of the parathyroid glands in children. This workflow model can be the first step in reducing the rate of postoperative hypocalcemia in children. 3
20 | wetenschapsdag 2023 Lopend onderzoek in de regio Amsterdam 4 Auteurs L. Rijken, K.K. Yeung, M.P. Schijven Abstract titel Developing Trustworthy Artificial Intelligence (AI)-driven Tools to Predict Abdominal Aortic Aneurysm Progression and the Risk of Adverse Cardiovascular Events: the VASCULAID-RETRO Study Background To date, it is unknown which patients with an abdominal aortic aneurysm (AAA) will suffer cardiovascular events or in which patients the AAA will progress. The VASCULAID-RETRO study aims to develop artificial intelligence (AI) algorithms able to evaluate the extent of AAA disease progression and risk of cardiovascular events. Methods The VASCULAID-RETRO study aims to leverage retrospectively collected data of at least 5000 AAA patients from multiple European clinical centers for the development of AI-algorithms. Initially, a robust data infrastructure network will be established to gather standardized data from all six participating clinical centers. After collection of imaging, -omics data, and (reported) clinical patient data, AI-tools will be developed using this data. Automatic anatomical segmentation on images and image analysis on US, CTA and MRI will be performed. Moreover, prediction algorithms for each data type (imaging, -omics, and clinical data) will be created separately. These prediction algorithms will be merged using fusion AI models to build a comprehensive prediction algorithm based on multi-source data to generate overall risk scores or probabilities for AAA progression and the risk of cardiovascular events. Results Ethical approval for retrospective patient data collection have been secured by all clinical partners. Currently, the data infrastructure for the collection of the retrospective data is being developed. Patient data from electronic patient files will be collected in Castor EDC and imaging will be stored on an XNAT server. Conclusion FUTURE PERSPECTIVE: The VASCULAID-RETRO AAA study is part of the VASCULAID project, an European Horizon-funded research project. Similar AI algorithms will be developed for patients with peripheral arterial disease (PAD) of the lower limbs. Following the VASCULAID-RETRO studies for AAA and PAD patients, prospective studies will be performed in which more data will be collected and the developed AI-algorithms will be validated for identifying AAA and PAD patients at high risk of disease progression and cardiovascular events.
wetenschapsdag 2023 | 21 Sessie 1a: Viatris: Pantastische Pancreas-Perikelen Sessie 1a: Viatris: Pantastische Pancreas-Perikelen 11.00 - 12.00, Concertzaal Voorzitters: Koert Kuhlmann Tara Mackay 1 J.R. Puik - Predictive value of miR-379 for response to first-line chemotherapy in advanced pancreatic cancer 2 A.M.L.H. Emmen - Implementation and outcome of minimally invasive pancreatoduodenectomy in Europe: A critical appraisal of the first 3 years of the E-MIPS registry 3 C.A. Leseman - Nationwide outcomes per type of pancreatectomy for intraductal papillary mucinous neoplasm: ‘heads or tails’ or should guidelines take type of resection required into account? 4 N. De Graaf - First experience of robotic versus open pancreatoduodenectomy: a nationwide propensity-score matched analysis 5 M. Zwart - Video analysis of gastro-jejunostomy to predict delayed gastric emptying after robotic pancreatoduodenectomy 6 C.L. Bruna - Histopathological appraisal of splenic hilum lymphadenectomy during distal pancreatectomy for pancreatic cancer: predefined subanalysis of the DIPLOMA trial
22 | wetenschapsdag 2023 Sessie 1a: Viatris: Pantastische Pancreas-Perikelen x1 Auteurs J. R. Puik, L. N.C. Boyd, M. Ali, T. Y.S. Le Large, L L. Meijer, H. W.M. van Laarhoven, E. Giovannetti, G. Kazemier Abstract titel Predictive value of miR-379 for response to first-line chemotherapy in advanced pancreatic cancer Background Firstl line systemic treatment of patients with advanced pancreatic ductal adenocarcinoma (PDAC) consists of combined chemotherapeutic regimens of FOLFIRINOX or gemcitabine with nab-paclitaxel. Drug resistance, however, hampers the success and benefit that patients can experience from these chemotherapeutic strategies. Predictive biomarkers are necessary to guide individualized clinical decision-making. This study assesses the value of miRNAs to predict response to FOLFIRINOX vs gemcitabine-nab-paclitaxel in advanced PDAC. Methods Next-generation sequencing was used for biomarker discovery in 24 pre-treatment serum samples from metastatic PDAC patients treated with FOLFIRINOX or gemcitabine-nab-paclitaxel. The top 4 candidate biomarkers (miR-127, miR-155, miR-200, and miR379) were validated by PCR in a separate cohort of 37 patients with advanced PDAC. Cox regression models and ridge regression models were used to assess the association between miRs and the therapy effect of FOLFIRINOX vs gemcitabine-nab¬-paclitaxel in terms of overall survival. Results In the validation cohort, higher miR-379 was strongly predictive of treatment efficacy (interaction test, P=0.0004), and remained predictive after correction for confounding by age and sex. FOLFIRINOX was significantly better than gemcitabine-nabpaclitaxel in the subset of patients with lower than median miR-379 (hazard ratio, 0.32 [95% confidence interval, 0.08 to 0.98]; P=0.046), while gemcitabine-nab-paclitaxel was superior in the subset of patients with higher than median miR-379 (hazard ratio, 0.28 [0.10 to 0.86]; P=0.027). In contrast, there was no evidence for an association between therapy response and miR-155 or miR-200 levels (interaction test, P=0.36 and P=0.19, respectively), while miR127 was moderately predictive of treatment effects (interaction test, P=0.036). Conclusion Pursuant to further validation in larger observational studies, miR379 could serve as a predictive biomarker to guide individualized clinical decision-making between FOLFIRINOX and gemcitabinenab-paclitaxel for patients with advanced PDAC.
wetenschapsdag 2023 | 23 Sessie 1a: Viatris: Pantastische Pancreas-Perikelen x2 Auteurs A.M.L.H. Emmen, N. de Graaf, I.E. Khatkov, O.R. Busch, S. Dokmak, U. Boggi, B. Groot Koerkamp, G. Ferrari, I.Q. Molenaar, O. Saint-Marc, M. Ramera, D.J. Lips, J.S.D. Mieog, M.D.P. Luyer, T. Keck, M. D’Hondt, F.R. Souche, B. Edwin, T. Hackert, M.S.L. Liem, A. Iben-Khayat, H.C. Van Santvoort, M. Mazzola, R.F. De Wilde, E.F. Kauffmann, B. Aussilhou, S. Festen, R. Izrailov, P. Tyutyunnik, M.G. Besselink*, M. Abu Hilal*, for the European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS) Abstract titel Implementation and outcome of minimally invasive pancreatoduodenectomy in Europe: A critical appraisal of the first 3 years of the E-MIPS registry Background International multicenter audit-based studies focusing on outcomes of minimally invasive pancreatoduodenectomy (MIPD) are lacking. The European registry for Minimally Invasive Pancreatic Surgery (E-MIPS) is an E-AHPBA endorsed registry which aims to monitor and safeguard the introduction of MIPD in Europe. Methods A planned analysis of outcomes among consecutive patients after MIPD from 45 centres in 14 European countries in the E-MIPS registry (2019-2021). Main outcomes of interest were major morbidity (Clavien-Dindo grade ≥3) and 30-day/in-hospital mortality. Results Overall, 1,336 patients after MIPD were included (835 robotassisted (R-MIPD) and 501 laparoscopic MIPD (L-MIPD)). Overall, 20 centres performed R-MIPD, 15 centres L-MIPD, and 10 centres both. Between 2019 and 2021, the rate of centres performing L-MIPD decreased from 46.9% to 25%, whereas for R-MIPD this increased from 46.9% to 65.6%. Overall, the rate of major morbidity was 41.2%, 30-day/in-hospital mortality 4.5%, conversion rate 9.7%, postoperative pancreatic fistula grade B/C 22.7%, and postpancreatectomy haemorrhage grade B/C 10.8%. Median length of hospital stay was 12 days [IQR 8-21]. The number of centres meeting the Miami Guidelines cut-off of ≥20 MIPDs annually increased from 9 (28.1%) in 2019 to 12 (37.5%) in 2021 (P=0.424). Rates of conversion (7.4% vs 14.8% P<0.001) and reoperation (8.9% vs 15.1%) P<0.001) were lower in centres that met the Miami cut-off. Conclusion During the first 3 years of the pan-European MIPS registry, morbidity and mortality rates after MIPD were acceptable. A shift is ongoing from L-MIPD to R-MIPD. Variations in outcomes should be further evaluated over a longer time period.
24 | wetenschapsdag 2023 Sessie 1a: Viatris: Pantastische Pancreas-Perikelen x3 Auteurs C.A. Leseman, T.Y.S.. le Large, L. Brouwer-Hol, M.W.J. Stommel, B.A. Bonsing, C. van Eijck, R.P. Voermans, S. Lekkerkerker, B. Groot Koerkamp, H.C. van Santvoort, O.R. Busch, I.Q. Molenaar, G. Kazemier, M.G. Besselink Abstract titel Nationwide use and outcome of pancreatectomy for IPMN: should guidelines take the type of pancreatic resection required into account Background Current guidelines on intraductal papillary mucinous neoplasm (IPMN) do not take the location of IPMN (e.g. pancreatic head, body, tail) and the associated required pancreatic resection into account when advising pancreatic resection. This could be relevant as outcomes may differ although large multicenter studies on the outcome of pancreatoduodenectomy, left-sided pancreatectomy, and total pancreatectomy for IPMN are lacking. Therefore, this nationwide study aimed to evaluate the outcomes associated with pancreatectomy for IPMN. Methods Nationwide, retrospective analysis of all consecutive patients after pancreatectomy for pathology proven IPMN from the mandatory prospective Dutch Pancreatic Cancer Audit (2014-2020). Primary outcomes were in-hospital/30-day mortality and major morbidity (Clavien-Dindo grade 3). Only complications defined as ISGPS grade B/C were included. Trends in use and outcomes per pancreatectomy were evaluated. Results Overall, 396 patients underwent pancreatectomy for IPMN, including pancreato-duodenectomy (PD; n = 246, 62%), left-sided pancreatectomy (LP; n = 130, 33%), and total pancreatectomy (TP; n = 20, 5%). The rate of in-hospital/30-day mortality was 2.0% and did not differ significantly between groups (2.8%, 0%, 5.0%, p = 0.257). The rate of major morbidity was 32% and did not differ significantly (36%, 25%, 25% p = 0.545). The rates of postoperative pancreatic fistula (POPF; 17%, 15%, NR, p = 0.140) and bile leak (12%, NR, 5%, p = 0.694) did not differ significantly between groups, whereas delayed gastric emptying was reported more often after PD (DGE; 23%, 2%, 20%, p = 0.0001). Mean length of hospital stay was 14.7 days (SD 14.6) and shortest after LP (17.8, 8.8, 15.1 days, p<0.001). The 30-day readmission rate was the highest after PD (27%, 18%, 0%, p = 0.003). Final pathology showed high grade dysplasia (HGD) in 69 patients (17%), mostly after TP (20%, 10%, 40%, p <0.001). The use of pancreatectomy for IPMN remained stable, whereas the use of TP decreased (Pearson r 0.281; -0.579, respectively).
wetenschapsdag 2023 | 25 Sessie 1a: Viatris: Pantastische Pancreas-Perikelen Conclusion This study found no significant differences in terms of mortality and major morbidity among three types of pancreatectomy for IPMN. These findings do not justify an altered threshold for surgical resection based the type of pancreatic resection required for IPMN. Notably, long-term outcomes associated with different types of pancreatectomy were not taken into account in the present study.
26 | wetenschapsdag 2023 Sessie 1a: Viatris: Pantastische Pancreas-Perikelen x4 Auteurs N. de Graaf, M. J.W. Zwart, J. van Hilst, O. R. Busch, F. Daams, S. van Dieren, S. Festen, D. J. Lips, M. D.P. Luyer, J.S.D. Mieog, I. Quintus Molenaar*, B. Groot Koerkamp*, M. G. Besselink* for the Dutch Pancreatic Cancer Group Abstract titel First experience of robotic versus open pancreatoduodenectomy: a nationwide propensity-score matched analysis Background While robotic pancreatoduodenectomy (RPD) has shown promising outcomes in experienced high-volume centers, it is unclear whether implementation on a nationwide scale is safe and beneficial. This study compared the outcomes of early experience with RPD versus conventional open pancreatoduodenectomy (OPD) in the Netherlands, focusing on patient safety. Methods A nationwide retrospective cohort study of all consecutive patients undergoing RPD and OPD registered in the mandatory Dutch Pancreatic Cancer Audit (18 centers, 2014-2021), starting from the first RPD procedures per center. Main endpoints were major complications (Clavien-Dindo ≥3) and in-hospital/30-day mortality. Propensity-score matching (1:1) was used to minimize selection bias. Sensitivity analyses on learning curve, volume, and indications were performed. Results Overall, 701 patients after RPD and 4447 after OPD were included. Among the eight centers that started RPD during the inclusion period, the median RPD experience was 86 (range 48-149), with a 7.3% conversion rate. After matching (698 RPD vs. 698 OPD controls), no significant differences were found in major complications (40.3% vs. 36.2%, P=0.186), in-hospital/30-day mortality (4.0% vs. 3.1%, P=0.326), postoperative pancreatic fistula grade B/C (24.9% vs. 23.5%, P=0.578) and post-pancreatectomy hemorrhage grade B/C (12.5% vs 9.6%, P=0.111). RPD was associated with longer operative time (359 vs. 301 min, P<0.001), less intraoperative blood loss (200 vs. 500 mL, P<0.001), fewer wound infections (7.4% vs. 12.2%, P=0.008), and shorter hospital stay (11 vs. 12 days, P<0.001) than OPD. In patients with pancreatic cancer (N=453), no difference was found in R0-resection rate (60.1% vs. 54.6%, P=0.106). Centers performing ≥20 RPDs annually had lower mortality (2.9% vs. 7.3%, P=0.009) and conversion rates (6.3% vs. 11.2%, P=0.032).
wetenschapsdag 2023 | 27 Sessie 1a: Viatris: Pantastische Pancreas-Perikelen Conclusion This study demonstrates that RPD was safely implemented nationwide, without significant differences in major morbidity and mortality compared with matched OPD patients. Randomized trials should verify these findings and confirm the observed benefits of RPD versus OPD.
28 | wetenschapsdag 2023 Sessie 1a: Viatris: Pantastische Pancreas-Perikelen x5 Auteurs M. Zwart, B. den Broek, D. Paijens, T. Geraedts, R. Schipper, S. Zwetsloot, A. Comandatore, O. Busch, K. Tran, M. Luyer, J. Schreinemakers, J. Wijsman, G. van der Schelling, I. de Hingh, S. Mieog, B. Bonsing, K. Takagi, R. de Wilde, L. Morelli, H. Zeh, A. Zureikat, M. Hogg, B. Groot Koerkamp, M. Besselink, for the Dutch Pancreatic Cancer Group Abstract titel Video analysis of gastro-jejunostomy to predict delayed gastric emptying after robotic pancreatoduodenectomy Background Robotic pancreatoduodenectomy (RPD) has proven to be as safe as open pancreatoduodenectomy (OPD), sometimes even more favorable in terms of overall length of hospital stay and complication rates. However, postoperative incidence of morbidity is still substantial, such as delayed gastric emptying. To this day, improved surgical performance has not yet been linked to a decrease in delayed gastric emptying in RPD. The aim of this study is to identify learning curves for robotic gastric anastomosis during RPD and the predictive value of the objective structured assessment of technical skills (OSATS) score for delayed gastric emptying according to the Birkmeyer and UPMC method. Methods Videos of gastric anastomosis during RPD were analyzed in a retrospective multicenter (LAELAPS 3) cohort by two blinded graders. Surgical performance was scored with OSATS. The main outcome measures are the combined OSATS scores of two blinded graders over time (learning curve). Secondary outcome is the correlation between OSATS scores and delayed gastric emptying (DGE, grade B/C). Results Videos from 192 gastric anastomosis were included. DGE occurred in 42/192 (21.9%) of patients. Mean OSATS score was 22.5 (SD±5.0) and was significantly predictive for DGE (AUC 0.668, P<0.001). The significant predictive OSATS elements were: Gentleness (AUC 0.719, P<0.001), instrument handling (AUC 0.595 P=0.043), tissue exposure (AUC 0.625, P=0.009), summary score (AUC 0.665, P25 points remained a consistent predictor (OR 0.344, P=0.028).
wetenschapsdag 2023 | 29 Sessie 1a: Viatris: Pantastische Pancreas-Perikelen Conclusion Using OSATS to score the gastric anastomosis in RPD is a useful for identifying learning curves. Higher OSATS scores decreased the risk of DGE, making OSATS a predictor for post-operative delayed gastric emptying. OSATS could serve as a tool for assessment of robotic gastric anastomoses, e.g., in training programs and implementation.
30 | wetenschapsdag 2023 Sessie 1a: Viatris: Pantastische Pancreas-Perikelen x6 Auteurs C. L Bruna, J. van Hilst, A. Esposito, D. Kleive, M. Falconi, J.N. Primrose, M. Korrel, A. Zerbi, A. Kokkola, G. Butturini, B. Björnsson, R. Casadei, R. Marudanayagam, M.G. Besselink, M. Abu Hilal* Abstract titel Histopathological appraisal of splenic hilum lymphadenectomy during distal pancreatectomy for pancreatic cancer: predefined subanalysis of the DIPLOMA trial Background Splenectomy during distal pancreatectomy is considered to be standard in the surgical management of resectable left-sided pancreatic ductal adenocarcinoma (PDAC). This is justified by the need to obtain a complete lymphadenectomy. However, scientific evidence supporting this approach is still lacking. We aim to perform the appraisal of splenic hilum lymph node involvement in distal pancreatectomy specimens examined in the DIPLOMA trial using standardized pathology procedures. Methods The international randomized patient- and pathologist-blinded DIPLOMA-trial enrolled 258 patients with resectable pancreatic body and tail cancer between minimally invasive and open distal pancreatectomy (May 8, 2018 - May 7, 2021), of which patients with PDAC were included in the present predefined subanalysis. The primary outcome was the number of identified and positive lymph nodes (LNs) in the splenic hilum. The secondary outcome was survival in patients with and without splenic hilum LN metastasis. Cox regression analyses were performed to determine whether splenic LN metastasis predict survival. Results In total, 185 patients were included in the present analysis. Medium number of identified LNs was 23.0 (IQR 15.0–32.0) , and median number of identified LNs in the splenic hilum was 3.0 (IQR 1.0-6.0). Notably, only four patients (4/185; 2.2%) had splenic hilum LN metastasis, of whom three patients had pancreatic tail cancer and one patient had pancreatic body cancer. Of these, three patients also had LN metastases superior and inferior of the pancreas. Median survival of four patients with splenic hilum LN metastasis was 17 months [range 13-36]. Median survival in patients without splenic hilum LN metastasis was not reached (30-months survival rate 60%) (p = 0.714). Upon Cox regression analysis, the small number of patients with splenic hilum LN metastasis prevents a firm conclusion on its role as an independent predictor of survival.
wetenschapsdag 2023 | 31 Sessie 1a: Viatris: Pantastische Pancreas-Perikelen Conclusion In the present study, the rate of splenic hilum LN metastasis was < 5% and its predictiveness on survival in patients undergoing distal pancreatectomy for left-sided pancreatic cancer is not well known. The need for standard splenectomy in distal pancreatectomy for PDAC may need to be reevaluated.
32 | wetenschapsdag 2023 Sessie 1b: Ticks, Checks and Balances Sessie 1b: Ticks, Checks and Balances 11.00 - 12.00, Teekenzaal Voorzitters: Freek Daams Max Knaapen 1 W.Y. van der Plas - Diagnostic accuracy of imaging for intraoperative localization of parathyroid adenoma in patients with primary hyperparathyroidism 2 A. de Wit - Comparison of compliance to an enhanced study protocol to prevent from colorectal anastomotic leakage between the DoubleCheck and SmartCheck study 3 E.E. van der Meulen - Impact of anastomotic bowel leakage on oncological outcomes and stoma presence 4 E.G.M. van Geffen - Evaluation of clinical nature, treatment and oncological outcomes of locally recurrent rectal cancer over time: results from two national cross-sectional cohort studies 5 L.S. Blaas - Hemiarthroplasty versus ORIF for complex, severely displaced proximal humerus fractures in middle-aged patients
wetenschapsdag 2023 | 33 Sessie 1b: Ticks, Checks and Balances x1 Auteurs W.Y. van der Plas, M. Tulu, E.J.M. Nieveen van Dijkum, K. in ´t Hof, A.F. Engelsman Abstract titel Diagnostic accuracy of imaging for intraoperative localization of parathyroid adenoma in patients with primary hyperparathyroidism Background Accurate preoperative adenoma localization facilitates minimal invasive parathyroidectomy (MIP) and is crucial for successful treatment of primary hyperparathyroidism (pHPT). However, no consensus has been reached on the type of imaging modality to be used as the gold standard. We aimed to determine and compare the diagnostic accuracy of frequently applied imaging modalities, including ultrasound (US) in combination with Technetium-99m (99mT) sestamibi SPECT/CT scan, 4D-CT scan, and PET-CT scan. Methods A retrospective analysis was conducted including patients who underwent MIP for pHPT from three hospitals in The Netherlands. The imaging accuracy was assessed by calculating sensitivity and positive predictive value (PVV) for different imaging techniques and used imaging modalities were correlated with patient characteristics. Results In total, 189 patient were included for analysis of which 169 patients (89.4%) with a pathologist confirmed parathyroid adenoma (positive pathology result) and in 20 patients (10.6%) preoperative localization did not match with the pathology findings. PET-CT scan had the highest PPV of 96.2%. The PPV of 4D-CT was 75.0%, and US in combination with 99mTc sestamibi SPECT/CT scan had a PPV of 84.0%. The percentage of patients requiring a second modality because of inconclusive results was 27% for 4D-CT, 29% for PET-CT, 46% for US/SPECT respectively (p=0.041). Patients who required secondary imaging were older, (p=0.018), had more frequently a genetic parathyroid disorder (p=0.04) and a lower adenoma weight (p=0.01) compared to those who required only the one imaging modality. Conclusion PET-CT scan has a high PPV and required the lowest rate of secondary imaging. and its use in preoperative planning of MIP may be considered more frequently.
34 | wetenschapsdag 2023 Sessie 1b: Ticks, Checks and Balances x2 Auteurs A. de Wit, B.T. Bootsma, D.E. Huisman, F. Daams Abstract titel Comparison of compliance to an enhanced study protocol to prevent from colorectal anastomotic leakage between the DoubleCheck and SmartCheck study Background Colorectal anastomotic leakage (CAL) remains a severe complication after bowel resection with creation of an anastomosis. Our recent LekCheck study (LC) identified six modifiable CAL risk factors. The DoubleCheck (DC) and SmartCheck (SC) studies were designed to improve the intraoperative condition of patients by implementing an enhanced intervention bundle, and determining its effect on CAL. This observational study aims to examine which introduction style results in better compliance to a new study protocol. Methods Both are multi-center open-labelled trials with historical controls, implementing an enhanced care protocol during creation of the anastomosis to minimize exposure to: anemia, hyperglycemia, hypothermia, epidural anesthesia, inotropic drug administration and incorrect antibiotic prophylaxis. Both studies used identical protocols, but they were only obligated in the DC, whereas the SC study consisted of a purely observational checklist. The study endpoint is the intraoperative condition measured as exposure to the risk factors. Results 1100 patients were included in this study (867 DC; 233 SC). In the previous LC study patients were exposed to a mean of 1.62 (0 – 6) risk factors at the time of the creation of the anastomosis, compared to 1.54 (0 – 4) in the DC and 1.88 (0 – 5) in the SC (p <0.001). Conclusion Obligated implementation of a quality improvement protocol proved to have superior compliance over an observational checklist. Additional results are being collected to assess whether different compliance results in different CAL rates.
wetenschapsdag 2023 | 35 Sessie 1b: Ticks, Checks and Balances x3 Auteurs E.W. Ingwersen, D.E. Huisman, E.E. van der Meulen, B.T. Bootsma, G. Kazemier, H.M. Kroon, I. Murshed, T. Sammour, F. Daams Abstract titel Impact of anastomotic bowel leakage on oncological outcomes and stoma presence Background Literature on the long-term effects of anastomotic bowel leakage (ABL) with regards to postoperative oncological outcomes and stoma presence is equivocal. Understanding the association between ABL and long-term outcomes is crucial for patient follow-up, counseling, and tailored treatment decisions. Objective was to investigate the impact of ABL on cancer recurrence and stoma presence in patients undergoing colon and rectal cancer surgery. Methods This prospective cohort study was conducted in patients included in the LekCheck study. Follow-up period was 5 years. This multicenter international study conducted in 14 hospitals in three countries including patients undergoing colon cancer surgery and rectal cancer surgery and were analyzed separately. Patients with a primary anastomosis were included. The outcomes assessed were cancer recurrence rate, overall survival, disease-free survival, and stoma presence at five years of follow-up, stratified based on ABL. Results A total of 1 042 patients were included. ABL was not significantly associated with cancer recurrence, overall survival, or disease-free survival after colon or rectal cancer surgery. However, for colon cancer surgery, ABL was associated with the presence of a stoma at five years of follow-up (18.8% vs 1.9%, odds ratio 16.96, 95% confidence interval 8.69 – 33.10, P<0.001). Similarly, in rectal cancer surgery, stoma presence at five years was significantly higher in patients after ABL (21.9% vs 1.9%, odds ratio 5.61, 95% confidence interval 1.82 - 17.27, P<0.001). Conclusion This study did not demonstrate a negative impact of ABL on oncological outcomes. However, ABL was strongly associated with an increased incidence of stoma presence after five years, significantly affecting the patients’ quality of life after colon and rectal cancer surgery.
36 | wetenschapsdag 2023 Sessie 1b: Ticks, Checks and Balances 4 Auteurs E.G.M. van Geffen, J.A.M. Langhout, S.A. Hazen, T.C. Sluckin, G.L. Beets, R.G.H. Beets-Tan, W.A.A. Borstlap, K. Horsthuis, M.P.W. Intven, C.A.M. Marijnen, P.J. Tanis, M. Kusters, on behalf of the Dutch Snapshot Research Group Abstract titel Evaluation of clinical nature, treatment and oncological outcomes of locally recurrent rectal cancer over time: results from two national cross-sectional cohort studies Background In the Netherlands, there has been a reduction in radiotherapy usage for rectal cancer. While this decrease has not compromised oncological outcomes, neoadjuvant radiotherapy of the primary tumour is thought to affect the treatability of locally recurrent rectal cancer (LRRC). This study aims to evaluation the clinical nature, treatment and oncological outcomes of locally recurrent rectal cancer over time, by studying two national cross-sectional cohort studies. Methods All patients who underwent a total mesorectal excision in 2011 (n=2095) and 2016 (n=2855) for their primary tumour were included with a 4-year follow up and were merged from two nationwide cohort studies. Main outcomes included time to LRRC, synchronous metastases at time of LRRC diagnosis, intention of treatment and 2-year overall survival (OS) after LRRC. Results Between 2011 and 2016 a decrease in neoadjuvant (chemo) radiotherapy from 89.2% to 60.0% was observed. The 3-year LR rate was 5.5% in 2011 (n=95, median time to LRRC 18 months) compared to 6.8% in 2016 (n=173, p=0.121, median time to LRRC 16 months). No difference between synchronous metastases at time of LRRC diagnoses was found (26.2% in 2011; 32.5% in 2016, p=0.250). The intention of treatment shifted towards more curative treatment in 2016 compared to 2011 (38.0% vs 21.5%, p=0.003). Two-year OS after LRRC diagnoses increased from 30.4% in 2011 to 49.9% in 2016 (p=0.002), and from 47.5% to 78.7% when stratified for curative intent (p=0.006). Conclusion There was a significant increase in curative treatment and OS in 2016 compared to 2011. Factors that might contribute to this might be the decrease in neoadjuvant radiotherapy for the primary tumour, centralization of care and more extensive treatment options for LRRC and metastases.
wetenschapsdag 2023 | 37 Sessie 1b: Ticks, Checks and Balances 5 Auteurs L.S. Blaas, R.L.O.M.A. Bent, T.D.W. Alta, A van Noort, R.J. Derksen Abstract titel Hemiarthroplasty versus ORIF for complex, severely displaced proximal humerus fractures in middle-aged patients Background The optimal treatment for complex proximal humerus fractures (PHFs) remains unknown. Conservative treatment is standard for minimally displaced fractures, while reverse shoulder arthroplasty is increasingly popular for complex fractures in elderly. However, for middle-aged patients with highly complex fractures, sound evidence for treatment is missing. Treatment with open reduction and internal fixation (ORIF) can be challenging and literature opts for hemiarthroplasty (HA) as a viable treatment option, nevertheless, HA is becoming less popular. Therefore, we hypothesized that in patients with a complex PHF with an intact rotator cuff, a wellperformed fracture HA could be the best available option, as opposed to ORIF. Methods In this retrospective, multicenter comparative cohort-study, 30 patients with complex PHFs were included. Ten patients underwent HA and those were matched to 20 with an ORIF. All patients had at least one-year follow-up. Patient-reported outcome measures (PROMs) were assessed: Constant-Murley Score (CMS), Oxford Shoulder Score (OSS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and the pain was assessed with the Visual Analogue Score (VAS). In addition, the range of motion (ROM) and complications were evaluated. Results The mean age for HA and ORIF treated patients was 55.4 vs. 56.3 years. The HA group had a statistically significant higher number of patients with head-split fractures. For PROMs, the following means (CI-95%) for HA versus ORIF were, respectively 26.8 (6.2 – 47.4) vs 28.6 (22.1 – 35.1) for DASH, 37.3 (28.5 – 46.1) vs 37.4 (34.1 – 40.6) for OSS, 25.9 (7.9 – 43.9) vs 21.4 (13.0 – 29.7) for CMS, 64.2 (44.7 – 83.7) vs 71.0 (63.8 – 78.2) for CMS fracture side. No statistically significant differences were found. For ROM, forward flexion 110.5 (80.7 – 140.3) vs 116.2 (98.0 – 134.4), abduction 107.4 (73.9 – 140.9) vs 105.3 (83.0 – 127.6) and external rotation 26.3 (2.4 – 50.2) vs 27.4 (18.7 – 36.1) also showed no statistically significant differences. However, in both groups, high complication and revision rates were found. With more revisions in the HA group (50%) compared to the ORIF group (30%).
38 | wetenschapsdag 2023 Sessie 1b: Ticks, Checks and Balances Conclusion For middle-aged patients with complex PHFs, this study concludes that there are no statically significant differences between treatment with a HA or ORIF. Overall the PROMs and ROM show good outcomes. However, both groups experienced high complication and revision rates, with a higher revision rate observed in the HA group. Consequently, HA should only be considered for patients aged between 50-60 years with head-split fractures, fracture dislocation, or severely displaced multipart fractures.
wetenschapsdag 2023 | 39 Sessie 1c: We Zullen Doorgaan Sessie 1c: We Zullen Doorgaan 11.00 - 12.00, Shaffyzaal Voorzitters: Anke Kuijpers Didi Sloothaak 1 M . Zeeuw - Total tumor volume assessment in patients with colorectal liver metastases: an alternate prognostic biomarker for recurrence 2 B. Ten Haaft - Robotic versus Open Hepatic Arterial Infusion Pump Placement for Unresectable Intrahepatic Cholangiocarcinoma: Results From a Prospective Multicenter Phase II Trial 3 S.I Kreisel - Quality of Life in Patients with A Perineal Hernia 4 C.A.L. Jonker - Complications of Chait Cecostomies for Antegrade Continence Enemas (ACE) in Children with Intractable Constipation and/or fecal incontinence; The Amsterdam Experience. 5 A.H.M. Mennen - The incidence, mortality, and treatment of paediatric pelvic ring fractures in two level 1 trauma centres in the Netherlands 6 M. Hoebink - Clinical outcomes of 5 000 IU heparin versus activated clotting time guided heparinization during non-cardiac arterial procedures: a propensity score matched analysis.
40 | wetenschapsdag 2023 Sessie 1c: We Zullen Doorgaan x1 Auteurs M. Zeeuw, A. Bakker, N. J. Wesdorp, M. Ali, K. Voigt, M. Starmans, J. Roor, J.T.M. van Waesberghe, J. van den Bergh, I. Nota, S. Moos, S. van Dieren, J. Stoker, D. Grunhagen, R. Swijnenburg, C.J.A. Punt, J. Huiskens, C. Verhoef, G. Kazemier and the Dutch Colorectal Cancer Group Liver Expert Panel Abstract titel Total tumor volume assessment in patients with colorectal liver metastases: an alternate prognostic biomarker for recurrence Background Colorectal cancer metastasizes to the liver in more than half of the patients, and after local treatment of the liver approximately 80% experiences recurrence of disease. This study aims to assess the prognostic value of total tumor volume (TTV) for recurrence-free survival in patients with colorectal liver metastases (CRLM), treated with induction systemic therapy followed by local treatment. Methods Patients with liver-only CRLM from the multicenter randomized clinical trial CAIRO5 (NCT02162563) that received induction systemic therapy followed by local treatment were included. Baseline TTV and change in TTV as response to systemic therapy were calculated using the CT scan before and after systemic treatment. The prognostic value of TTV and other clinical variables were assessed using multivariable Cox regression analyses. Results In total, 430 contrast-enhanced abdominal CT-scans with 2400 CRLM in 215 patients were included with a median baseline TTV of 48.5 ml [17.1-178.0] and absolute change in TTV of -21.1 ml [-81.3 to -6.2]. Baseline TTV and absolute change in TTV together had significant additional prognostic value over conventional clinical variables (likelihood ratio test, P = 0.021). Using baseline TTV, absolute delta TTV, CEA, number of metastases, lobar distribution and timing of metastases , two risk groups are created that show a significant difference in 6-month recurrence-free survival probability (high-risk: 44% vs low-risk: 72%; hazard ratio: 2.33 [1.72 to 3.16]; P < 0.0001). Conclusion TTV demonstrates independent prognostic value for recurrencefree survival and enhances the predictive accuracy of a Cox regression model that incorporates established prognostic factors. Further validation is warranted, but the incorporation of TTV into established prognostic models for patients with initially non-locally treatable CRLM has the potential to enhance risk stratification and facilitate personalized clinical decision-making.
wetenschapsdag 2023 | 41 Sessie 1c: We Zullen Doorgaan x2 Auteurs B. ten Haaft, S. Franssen, R.W.J. van Dorst, M. Rousian, G. Pilz da Cunha, R.F. de Wilde, J.I. Erdmann, B. Groot Koerkamp, J. Hagendoorn, R. Swijnenburg Abstract titel Robotic versus Open Hepatic Arterial Infusion Pump Placement for Unresectable Intrahepatic Cholangiocarcinoma: Results From a Prospective Multicenter Phase II Trial Background Hepatic arterial infusion pump (HAIP) chemotherapy is an effective treatment for patients with unresectable intrahepatic cholangiocarcinoma (iCCA). HAIP chemotherapy requires a catheter inserted in the gastroduodenal artery and a subcutaneous pump. The catheter can be placed with an open or robotic approach. This study aims to compare perioperative outcomes of robotic versus open HAIP placement in patients with unresectable iCCA. Methods We analyzed patients with unresectable iCCA included in the PUMP-II trial from January 2020 to September 2022 undergoing robotic or open HAIP placement at Amsterdam UMC, Erasmus MC, and UMC Utrecht. The primary outcome was time to functional recovery (TTFR). Results In total, 22 robotic and 28 open HAIP placements were performed. The median TTFR was 2 days after robotic versus 5 days after open HAIP placement (P<0.001). One patient (4.5%) in the robotic group underwent a conversion to open because of a large bulky tumor leaning on the hilum immobilizing the liver. Postoperative complications were similar; 36% (8/22) after robotic versus 39% (11/28) after open placement (P=1.000). The median length of hospital stay was shorter in the robotic group; 3 versus 5 days (P<0.001). All 22 robotic patients initiated HAIP chemotherapy post-surgery, this was 93% (26/28) in the open group (P=0.497). The median time to start HAIP chemotherapy was 14 versus 18 days (P=0.153), respectively. Conclusion Robotic HAIP placement in patients with unresectable iCCA is a safe and effective procedure and is associated with a significantly shorter TTFR and hospital stay than open HAIP placement.
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