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01-11-2017 | Pancreatic Tumors

Conversion of Minimally Invasive Distal Pancreatectomy: Predictors and Outcomes

Authors: Ibrahim Nassour, MD, MSCS, Sam C. Wang, MD, Matthew R. Porembka, MD, Mathew M. Augustine, MD, PhD, Adam C. Yopp, MD, John C. Mansour, MD, Rebecca M. Minter, MD, Michael A. Choti, MD, MBA, Patricio M. Polanco, MD

Published in: Annals of Surgical Oncology | Issue 12/2017

Abstract

Background

Data on the risk factors for conversion during minimally invasive distal pancreatectomy (MIDP) and its effect on postoperative outcomes are limited.

Methods

This retrospective study used the pancreas-targeted American College of Surgeons National Surgical Quality Improvement Program database to compare MIDP requiring unplanned conversion with completed MIDP and open distal pancreatectomy (ODP).

Results

Of the 2926 cases identified in this study, 48.8% had ODP, 42.8% had MIDP, and 7.9% had conversion to MIDP. The conversion rate was 15.3% overall, 17.3% for laparoscopic surgery, and 8.5% for robotic surgery (p < 0.001). The risk factors associated with conversion were higher body mass index (BMI), low preoperative albumin level, a current smoking habit, and malignant T3/T4 disease or chronic pancreatitis compared with benign tumor smaller than 5 cm. A robotic approach was associated with a lower adjusted conversion rate than laparoscopy (odds ratio [OR] 0.32; 95% confidence interval [CI] 0.19–0.52). After adjustment, conversion was associated with a higher overall complication rate than MIDP (OR 1.89; 95% CI 1.35–2.66) or ODP (OR 1.41; 95% CI 1.00–1.98).

Conclusions

Chronic pancreatitis, large malignant tumors, higher BMI, lower serum albumin, and a current smoking habit were shown to be independent risk factors for conversion during MIDP. A robotic approach was associated with a lower conversion rate than laparoscopic MIDP. Conversion of MIDP was associated with a higher overall complication rate than completed MIDP or ODP. Adequate patient selection for MIDP may prevent conversion and associated increased morbidity.

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Title: Conversion of Minimally Invasive Distal Pancreatectomy: Predictors and Outcomes
Authors: Ibrahim Nassour, MD, MSCS
Sam C. Wang, MD
Matthew R. Porembka, MD
Mathew M. Augustine, MD, PhD
Adam C. Yopp, MD
John C. Mansour, MD
Rebecca M. Minter, MD
Michael A. Choti, MD, MBA
Patricio M. Polanco, MD
Publication date: 01-11-2017
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 12/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-017-6062-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Conversion of Minimally Invasive Distal Pancreatectomy: Predictors and Outcomes

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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