Bret T. Petersen, MD, FASGE

Associate Editor



Bret T. Petersen, MD, FASGE, is Professor of Medicine in the Division of Gastroenterology and Hepatology at the Mayo Clinic in Rochester, Minnesota. His practice is focused in the Mayo Pancreas Clinic and the Advanced Endoscopy Group. His professional interests include pancreatic and biliary diseases, performance and outcomes of ERCP, and delivery of endoscopic services. At Mayo, Dr. Petersen is a past Director of Endoscopy and has served on multiple clinic and foundation committees. He has directed numerous American Society for Gastrointestinal Endoscopy (ASGE) and Mayo courses, particularly related to the performance of ERCP. He has received the Mayo Award for Excellence, GI Fellows Award for Outstanding Teacher, and Department of Medicine Laureate Award (GI), as well as the Master Endoscopist Award of the ASGE. Dr. Petersen is the incoming Secretary for (ASGE) and a past Chair of the Technology and Quality Assurance in Endoscopy committees.



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Premature Closure of Laparoscopic Whipple Trial Signals Importance of Asking About Experience and Outcomes

Bret T. Petersen, MD, FASGE reviewing van Hilst J, et al. Lancet Gastroenterol Hepatol 2019 Mar.

Laparoscopic surgery demonstrably reduces postoperative inflammatory response markers and duration of postoperative recovery for many procedures. Pancreatoduodenectomy (PD), or Whipple procedure, is among the most complex abdominal operations. Laparoscopic PD (LPD) is increasing in frequency, yet the learning curve and potential risks versus benefits remain incompletely defined. This Dutch multicenter, randomized, controlled study from 4 centers evaluated the safety and time to functional recovery (pain control, absence of infection, independent mobility, >50% daily caloric intake, and absence of IV fluid support) for LPD versus traditional open technique (OPD) in patients with malignant, premalignant, or benign conditions. All centers had moderate or greater volumes of PD procedures (>20/year), and participating surgeons had done 20 or more LPDs. Patients were blinded to the procedural technique. After 99 total procedures, the 90-day complication-related mortality of 5/50 (10%) in the LPD group and 1/49 (2%) in the OPD group (relative risk 4.90 [95% CI 0.59–40.44]; p=0.20) prompted premature termination of the study by the Data and Safety Monitoring Board. Median time to functional recovery (LPD 10 days vs OPD 8 days), Clavien-Dindo grade III or higher complications (LPD 50% vs OPD 39%), and grade B/C postoperative pancreatic fistulas (LPD 28% vs OPD 24%) were comparable between groups.

Unexpected safety concerns related to complication-related deaths in the LPD group, though not statistically greater, prompted discontinuation of the study. Time to functional recovery, while longer, was also not statistically different. These data differ from those of several single-arm series and two randomized trials, raising questions regarding the true learning curve and requisite volumes for more complex procedures compared to technically less challenging operations.

Bret T. Petersen, MD, FASGE
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van Hilst J, de Rooji T, Bosscha K, et al; Dutch Pancreatic Cancer Group. Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial. Lancet Gastroenterol Hepatol 2019;4:199-207. (