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The impact of unplanned conversion to an open procedure during minimally invasive pancreatectomy

Zachary E Stiles1, Paxton V Dickson1, Jeremiah L Deneve1

  • 1Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.

The Journal of Surgical Research
|May 29, 2018
PubMed
Abstract

Insights

Unplanned conversion during minimally invasive pancreatic resection (MIPR) increases patient morbidity and mortality. Outcomes after conversion are similar or worse than planned open surgery, highlighting key risk factors.

Area of Science:

  • Surgical Oncology
  • Minimally Invasive Surgery
  • Pancreatic Surgery

Background:

  • Minimally invasive pancreatic resection (MIPR) is increasingly common.
  • Outcomes following unplanned conversion to open surgery during MIPR are not well understood.

Purpose of the Study:

  • To assess short-term outcomes of unplanned conversion during MIPR.
  • To identify factors associated with unplanned conversion during MIPR.

Main Methods:

  • Retrospective cohort study using the ACS-NSQIP pancreatectomy-targeted data set.
  • Comparison of successful MIPR versus unplanned conversion.
  • Propensity matching to compare unplanned conversion with planned open pancreatectomy.

Main Results:

  • Unplanned conversion occurred in 24.6% of minimally invasive pancreatoduodenectomy (MIPD) and 19.6% of minimally invasive distal pancreatectomy (MIDP) cases.
  • Conversion was linked to higher morbidity and 30-day mortality compared to successful MIPR.
  • Converted patients had outcomes equivalent or inferior to planned open surgery.
  • Robotic approach was inversely associated with conversion for both MIPD and MIDP.

Conclusions:

  • Unplanned conversion during MIPR is associated with increased morbidity and mortality.
  • Outcomes after conversion are comparable to or worse than open pancreatectomy.
  • Risk factors for conversion, such as vascular resection, must be considered in surgical planning.
Keywords:
Minimally invasiveNSQIPOutcomesPancreasPancreatectomy

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