Impact of conversion to open surgery on outcomes following minimally invasive left-sided pancreatectomy

Minimally invasive surgery has increasingly been adopted for left-sided pancreatectomy, despite the known risks of conversion to open left-sided pancreatectomy. This study aimed to compare the outcomes of patients undergoing minimally invasive left-sided pancreatectomy, open left-sided pancreatectomy, and converted minimally invasive surgery to open left-sided pancreatectomy using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.

Adult patients who underwent elective left-sided pancreatectomy between 2019-2023 were classified into 3 groups: minimally invasive left-sided pancreatectomy, open left-sided pancreatectomy, and minimally invasive to open left-sided pancreatectomy. Patient demographics, intraoperative variables, and 30-day postoperative outcomes were compared between groups via univariate and multivariate analyses.

Of 11,262 patients, 5,458 (48.5%) underwent minimally invasive left-sided pancreatectomy, 5,145 (45.7%) underwent open left-sided pancreatectomy, and 659 (5.9%) required minimally invasive to open left-sided pancreatectomy conversion. Patients who required conversion were significantly older and had more comorbidities. The operative time was longer in the conversion group (275 minutes) than in the minimally invasive left-sided pancreatectomy (219 minutes) and open left-sided pancreatectomy (212 minutes) groups (P < .001). Outcomes were poorer for conversion, with higher rates of overall complications, major complications, and mortality than for minimally invasive left-sided pancreatectomy and open left-sided pancreatectomy (P < .001). Multivariate regression showed that conversion was independently associated with increased odds of major (odds ratio 1.381, 95% confidence interval, 1.149-1.660; P = .001) and overall complications (1.291, 1.083-1.538; P = .004).

Minimally invasive to open left-sided pancreatectomy conversion was associated with a significantly higher risk of postoperative complications. These findings likely reflect the underlying patient- and disease-related complexity rather than the conversion process or surgical approach alone. Improved preoperative risk stratification and patient selection may reduce unplanned conversion and improve outcomes after left-sided pancreatectomy.