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Robotic-assisted Lateral Pancreaticojejunostomy for Chronic Pancreatitis
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Risk of conversion to open surgery during robotic and laparoscopic pancreatoduodenectomy and effect on outcomes:
S Lof1,2, F L Vissers2, S Klompmaker2
1Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK.
Background:
Minimally invasive pancreatoduodenectomy (MIPD) is increasingly being performed because of perceived patient benefits. Whether conversion of MIPD to open pancreatoduodenectomy worsens outcome, and which risk factors are associated with conversion, is unclear.
Methods:
This was a post hoc analysis of a European multicentre retrospective cohort study of patients undergoing MIPD (2012-2017) in ten medium-volume (10-19 MIPDs annually) and four high-volume (at least 20 MIPDs annually) centres. Propensity score matching (1 : 1) was used to compare outcomes of converted and non-converted MIPD procedures. Multivariable logistic regression analysis was performed to identify risk factors for conversion, with results presented as odds ratios (ORs) with 95 per cent confidence intervals (c.i).
Results:
Overall, 65 of 709 MIPDs were converted (9.2 per cent) and the overall 30-day mortality rate was 3.8 per cent. Risk factors for conversion were tumour size larger than 40 mm (OR 2.7, 95 per cent c.i.1.0 to 6.8; P = 0.041), pancreatobiliary tumours (OR 2.2, 1.0 to 4.8; P = 0.039), age at least 75 years (OR 2.0, 1.0 to 4.1; P = 0.043), and laparoscopic pancreatoduodenectomy (OR 5.2, 2.5 to 10.7; P < 0.001). Medium-volume centres had a higher risk of conversion than high-volume centres (15.2 versus 4.1 per cent, P < 0.001; OR 4.1, 2.3 to 7.4, P < 0.001). After propensity score matching (56 converted MIPDs and 56 completed MIPDs) including risk factors, rates of complications with a Clavien-Dindo grade of III or higher (32 versus 34 per cent; P = 0.841) and 30-day mortality (12 versus 6 per cent; P = 0.274) did not differ between converted and non-converted MIPDs.
Conclusion:
Risk factors for conversion during MIPD include age, large tumour size, tumour location, laparoscopic approach, and surgery in medium-volume centres. Although conversion during MIPD itself was not associated with worse outcomes, the outcome in these patients was poor in general which should be taken into account during patient selection for MIPD.
Insights
Conversion during minimally invasive pancreatoduodenectomy (MIPD) is not associated with worse patient outcomes. Key risk factors for conversion include older age, larger tumors, and procedures in medium-volume centers.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Minimally invasive pancreatoduodenectomy (MIPD) is gaining traction due to potential patient benefits.
- Uncertainty exists regarding the impact of converting MIPD to open surgery on patient outcomes and the factors driving this conversion.
Purpose of the Study:
- To investigate whether conversion from MIPD to open pancreatoduodenectomy affects patient outcomes.
- To identify risk factors associated with conversion during MIPD procedures.
Main Methods:
- A post hoc analysis of a European multicenter retrospective cohort study (2012-2017) involving patients undergoing MIPD.
- Propensity score matching (1:1) was employed to compare outcomes between converted and non-converted MIPD cases.
- Multivariable logistic regression identified risk factors for conversion.
Main Results:
- Conversion occurred in 9.2% of MIPDs (65 of 709).
- Risk factors for conversion included larger tumor size (>40 mm), pancreatobiliary tumors, age ≥75 years, laparoscopic approach, and procedures in medium-volume centers.
- After propensity score matching, no significant differences in major complications (Clavien-Dindo grade ≥III) or 30-day mortality were observed between converted and non-converted groups.
Conclusions:
- Risk factors for MIPD conversion include patient age, tumor characteristics, surgical approach, and center volume.
- Conversion itself did not worsen outcomes, but overall outcomes for patients requiring conversion were generally poor, highlighting the importance of careful patient selection for MIPD.
