Publications by authors named "Nine de Graaf"
Nationwide practice change after early termination of a randomised trial of laparoscopic pancreatoduodenectomy.
Lancet Gastroenterol Hepatol
September 2025
Objective: To perform a cost-analysis during the implementation of robot-assisted pancreatoduodenectomy (RPD) in a high-volume center.
Background: Many high-volume centers are implementing RPD as alternative to open pancreatoduodenectomy (OPD) but the persevering concerns about increased costs of RPD versus OPD have not been addressed by large studies.
Methods: Post-hoc cost-analysis of consecutive RPD versus OPD in a singly high-volume center (Jan 2015-May 2024).
Article Synopsis
- A new surgery technique called minimally invasive pancreatoduodenectomy (MIPD) is being studied as a possible better option than the traditional open surgery (OPD) for pancreas problems.
- Researchers looked at data from hospitals in North America, Germany, the Netherlands, and Sweden from 2014 to 2020 and found that MIPD is used differently in each country.
- They discovered that more patients were getting MIPD over time, especially in North America and the Netherlands, but there were also higher risks of complications in some cases.
Article Synopsis
- Robotic pancreatoduodenectomy is gaining popularity globally, with positive outcomes reported, but more large-scale studies are needed to assess the impact of the learning curve on these results.* -
- An extensive study was conducted involving 2,186 patients from 18 centers in 8 countries, analyzing the learning curve and its effects on feasibility (operative time and blood loss) and proficiency (complications and morbidity).* -
- Findings revealed that a significant reduction in major morbidity occurred after 90 procedures, with improved outcomes across the board, while mortality rates remained steady throughout different experience levels among centers.*
Background: The efficacy and safety of minimally invasive distal pancreatectomy have been confirmed by randomized trials, but current patient selection and outcome of minimally invasive distal pancreatectomy in large international cohorts is unknown. This study aimed to compare the use and outcome of minimally invasive distal pancreatectomy in North America, the Netherlands, Germany, and Sweden.
Methods: All patients in the 4 Global Audits on Pancreatic Surgery Group (GAPASURG) registries who underwent minimally invasive distal pancreatectomy or open distal pancreatectomy during 2014-2020 were included.
Article Synopsis
- A nationwide study in the Netherlands aimed to compare the outcomes of robotic pancreatoduodenectomy and open pancreatoduodenectomy, focusing on safety and effectiveness across various centers from 2014 to 2021.
- The research included data from 701 patients who underwent robotic procedures and 4447 who had open surgery, with a focus on major complications and mortality rates.
- While robotic surgery had a longer operating time, it resulted in less blood loss, fewer infections, and shorter hospital stays, but it did not show significant differences in major complications or mortality compared to open surgery after matching the patient groups.
Article Synopsis
- There is a lack of international studies on the outcomes of minimally invasive pancreatoduodenectomy (MIPD), prompting the establishment of the European Registry for Minimally Invasive Pancreatic Surgery (E-MIPS) to monitor these procedures in Europe.
- An analysis of 1,336 patients from 45 centers across 14 European countries indicated significant outcomes, including a major morbidity rate of 41.2% and a 30-day/in-hospital mortality rate of 4.5%.
- Findings revealed that robot-assisted MIPD (R-MIPD) is becoming more popular than laparoscopic MIPD (L-MIPD), with better outcomes in terms of major morbidity and lower rates of complications when performed
Background: The introduction of modern chemotherapy a decade ago has led to increased use of neoadjuvant therapy (NAT) in patients with pancreatic ductal adenocarcinoma (PDAC). A recent North American study demonstrated increased use of NAT and improved operative outcomes in patients with PDAC. The aims of this study were to compare the use of NAT and short-term outcomes in patients with PDAC undergoing pancreatoduodenectomy (PD) among registries from the US and Canada, Germany, the Netherlands, and Sweden.
View Article and Find Full Text PDFBackground: Three randomized controlled trials have reported improved functional recovery after Laparoscopic pancreatoduodenectomy (LPD), as compared to open pancreatoduodenectomy (OPD). Long-term results regarding quality of life (QoL) are lacking. The aim of this study was to compare long-term QoL of LPD versus OPD.
View Article and Find Full Text PDFArticle Synopsis
- - Minimally invasive pancreatoduodenectomy (MIPD) is seen as a less harmful alternative to traditional open pancreatoduodenectomy (OPD), but its safety and recovery time compared to OPD require further investigation through large-scale trials.
- - The DIPLOMA-2 trial is a major international study involving 288 patients across 14 high-volume centers in Europe, evaluating MIPD against OPD, with a focus on overall complications and functional recovery time.
- - The trial will measure outcomes using the Comprehensive Complication Index (CCI®) and assess recovery times and other operative results to determine if MIPD offers significant benefits over OPD.
Objective: To develop and update evidence-based and consensus-based guidelines on laparoscopic and robotic pancreatic surgery.
Summary Background Data: Minimally invasive pancreatic surgery (MIPS), including laparoscopic and robotic surgery, is complex and technically demanding. Minimizing the risk for patients requires stringent, evidence-based guidelines.
Objective: To assess the feasibility, proficiency, and mastery learning curves for robotic pancreatoduodenectomy (RPD) in "second-generation" RPD centers following a multicenter training program adhering to the IDEAL framework.
Background: The long learning curves for RPD reported from "pioneering" expert centers may discourage centers interested in starting an RPD program. However, the feasibility, proficiency, and mastery learning curves may be shorter in "second-generation" centers that participated in dedicated RPD training programs, although data are lacking.
Introduction To provide high-quality surgical care, surgeons must critically appraise medical literature to adapt their clinical practice whenever convincing evidence emerges. This will promote evidence-based surgery (EBS). Over the last decade, we have organized monthly journal clubs (JCs) and more extensive quarterly EBS courses for surgical residents and PhD students, supervised by surgical staff.
View Article and Find Full Text PDFGrade II meningiomas are rarer than Grade I, and when operated on, bear a higher risk of local recurrence, with a 5-year progression free survival (PFS) ranging from 59 to 90%. Radiotherapy (RT) or radiosurgery, such as Gamma Knife radiosurgery (GKRS) can reduce the risk of relapse in patients with residual disease, even if their role, particularly after gross total resection (GTR), is still under debate. Main goal of this study was to compare the outcomes of different post-surgical management of grade II meningiomas, grouped by degree of surgical removal (Simpson Grade); next in order we wanted to define the role of GKRS for the treatment of residual disease or relapse.
View Article and Find Full Text PDFLaparoscopic versus open pancreatoduodenectomy for pancreatic or peri-ampullary tumours.
Lancet Gastroenterol Hepatol
September 2021
Background: Pancreatic resections are among the most technically demanding procedures, including a high risk of potentially life-threatening complications and outcomes strongly correlated to hospital volume and individual surgeon experience. Minimally invasive pancreatic resections (MIPRs) have become a part of standard surgical practice worldwide over the last decade; however, in comparison with other surgical procedures, the implementation of minimally invasive approaches into clinical practice has been rather slow.
Objective: The aim of this study was to highlight and summarize the available randomized controlled trials (RCTs) evaluating the role of minimally invasive approaches in pancreatic surgery.