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Conversion during Minimally Invasive Left Pancreatectomy: A Nationwide Study of Causes and Consequences
Charles De Ponthaud1,2,3, Alexandra Nassar4, Safi Dokmak5
1Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.
Annals of Surgery
|February 28, 2025
Summary
Conversion during minimally invasive left pancreatectomy (MILP) is predictable with a new Conversion Risk Score (CRS). This score aids surgeons in decision-making, as conversion is linked to severe postoperative complications.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Conversion from minimally invasive left pancreatectomy (MILP) affects 15-30% of procedures.
- Risk factors and outcomes associated with MILP conversion are not well-defined.
Purpose of the Study:
- Identify risk factors for conversion during MILP.
- Develop a predictive Conversion Risk Score (CRS).
- Assess the link between conversion and severe postoperative complications.
Main Methods:
- Retrospective nationwide multicenter study (2010-2021) of MILP patients.
- Multivariate analysis identified conversion risk factors.
- A CRS was developed and validated using training and validation sets.
- Propensity score analysis assessed the association between conversion and severe complications.
Main Results:
- Conversion occurred in 15.6% of 2104 MILP patients.
- Key risk factors included male sex, higher BMI, prior laparotomy, pancreatitis, larger tumors, and splenectomy or portal vein resection.
- A CRS using pre-operative variables (0-7 score) predicted conversion risk (2-100%).
- Conversion significantly correlated with severe complications (OR=1.80).
Conclusions:
- A predictive Conversion Risk Score (CRS) can be developed for MILP.
- The CRS aids surgeons in anticipating and managing conversion risk.
- Conversion during MILP is independently associated with increased severe postoperative complications.
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