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Risk Factors and Outcomes of Open Conversion During Minimally Invasive Major Hepatectomies: An International
Roberto Montalti1, Mariano Cesare Giglio1, Andrew G R Wu2
1Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy.
Annals of Surgical Oncology
|May 18, 2023
Summary
Minimally invasive major hepatectomies (MHs) have a 10.28% conversion rate to open surgery, influenced by various patient and surgical factors. Converted cases, particularly robotic ones, show poorer outcomes than non-conversions.
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Minimally invasive (MI) major hepatectomy (MH) adoption lags behind open surgery.
- Understanding conversion risk factors and outcomes is crucial for MI MH advancement.
Purpose of the Study:
- Evaluate risk factors for open conversion during MI MH.
- Compare outcomes of converted vs. non-converted MI MH.
- Assess the impact of laparoscopic vs. robotic approach on conversion and outcomes.
Main Methods:
- Retrospective analysis of 3880 MI MH cases (laparoscopic and robotic).
- Multivariate analysis, propensity score matching, and inverse probability treatment weighting.
- Analysis of risk factors and perioperative outcomes of open conversion.
Main Results:
- 10.28% of MI MHs required open conversion.
- Male sex, laparoscopic approach, cirrhosis, prior surgery, higher ASA score, and complex procedures increased conversion risk.
- Converted patients experienced longer operation times, increased blood loss, higher transfusion rates, longer hospital stays, and worse morbidity/mortality outcomes.
- Robotic MH had lower conversion rates but worse outcomes post-conversion compared to laparoscopic.
Conclusions:
- Several factors predict open conversion in MI MH.
- Conversion is associated with significantly poorer perioperative outcomes.
- While robotic surgery may reduce conversion rates, converted robotic procedures have inferior outcomes compared to converted laparoscopic procedures.
