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Conversion to open surgery in obese patients undergoing minimally invasive distal pancreatectomy: results from a multicenter analysis

Lookup NU author(s): Steven White

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Abstract

© 2024. Background: Although minimally invasive distal pancreatectomy (MIDP) is considered a standard approach it still presents a non-negligible rate of conversion to open that is mainly related to some difficulty factors, as obesity. The aim of this study is to analyze the preoperative factors associated with conversion in obese patients with MIDP. Methods: In this multicenter study, all obese patients who underwent MIDP at 18 international expert centers were included. The preoperative factors associated with conversion to open surgery were analyzed. Results: Out of 436 patients, 91 (20.9%) underwent conversion to open, presenting higher blood loss, longer operative time and similar rate of major complications. Twenty (22%) patients received emergent conversion. At univariate analysis, the type of approach, radiological invasion of adjacent organs, preoperative enlarged lymphnodes and ASA ≥ III were significantly associated with conversion to open. At multivariate analysis, robotic approach showed a significantly lower conversion rate (14.6 % vs 27.3%, OR = 2.380, p = 0.001). ASA ≥ III (OR = 2.391, p = 0.002) and preoperative enlarged lymphnodes (OR = 3.836, p = 0.003) were also independently associated with conversion. Conclusion: Conversion rate is significantly lower in patients undergoing robotic approach. Radiological enlarged lymphnodes and ASA ≥ III are also associated with conversion to open. Conversion is associated with poorer perioperative outcomes, especially in case of intraoperative hemorrhage.

Publication metadata

Author(s): Ausania F, Gonzalez-Abos C, Landi F, Martinie JB, Vrochides D, Walsh M, Hossain SM, White S, Prabakaran V, Melstrom LG, Fong Y, Butturini G, Bignotto L, Valle V, Bing Y, Xiu D, Di Franco G, Sanchez-Bueno F, de'Angelis N, Laurent A, Giuliani G, Pernazza G, Esposito A, Salvia R, Bazzocchi F, Esposito L, Pietrabissa A, Pugliese L, Memeo R, Uyama I, Uchida Y, Rios J, Coratti A, Morelli L, Giulianotti PC

Publication type: Article

Publication status: Published

Journal: HPB

Year: 2024

Volume: 26

Issue: 9

Pages: 1172-1179

Print publication date: 01/09/2024

Online publication date: 29/05/2024

Acceptance date: 27/05/2024

ISSN (print): 1365-182X

ISSN (electronic): 1477-2574

Publisher: Elsevier BV

URL: https://doi.org/10.1016/j.hpb.2024.05.016

DOI: 10.1016/j.hpb.2024.05.016

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