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- Title
Risk factors and outcomes of conversion in minimally invasive distal pancreatectomy: a systematic review.
- Authors
Balduzzi, A.; van der Heijde, N.; Alseidi, A.; Dokmak, S.; Kendrick, M. L.; Polanco, P. M.; Sandford, D. E.; Shrikhande, S. V.; Vollmer, C. M.; Wang, S. E.; Zeh, H. J.; Hilal, M. Abu; Asbun, H. J.; Besselink, M. G.
- Abstract
Purpose: The reported conversion rates for minimally invasive distal pancreatectomy (MIDP) range widely from 2 to 38%. The identification of risk factors for conversion may help surgeons during preoperative planning and patient counseling. Moreover, the impact of conversion on outcomes of MIDP is unknown. Methods: A systematic review was conducted as part of the 2019 Miami International Evidence-Based Guidelines on Minimally Invasive Pancreas Resection (IG-MIPR). The PubMed, Cochrane, and Embase databases were searched for studies concerning conversion to open surgery in MIDP. Results: Of the 828 studies screened, eight met the eligibility criteria, resulting in a combined dataset including 2592 patients after MIDP. The overall conversion rate was 17.1% (range 13.0–32.7%) with heterogeneity between studies associated with the definition of conversion adopted. Only one study divided conversion into elective and emergency conversion. The main indications for conversion were vascular involvement (23.7%), concern for oncological radicality (21.9%), and bleeding (18.9%). The reported risk factors for conversion included a malignancy as an indication for surgery, the proximity of the tumor to vascular structures in preoperative imaging, higher BMI or visceral fat, and multi-organ resection or extended resection. Contrasting results were seen in terms of blood loss and length of stay in comparing converted MIDP and completed MIDP patients. Conclusion: The identified risk factors for conversion from this study can be used for patient selection and counseling. Surgeon experience should be considered when contemplating MIDP for a complex patient. Future studies should divide conversion into elective and emergency conversion.
- Subjects
PANCREATECTOMY; PATIENT selection; DATABASE searching; PANCREAS; PANCREATIC tumors
- Publication
Langenbeck's Archives of Surgery, 2021, Vol 406, Issue 3, p597
- ISSN
1435-2443
- Publication type
Article
- DOI
10.1007/s00423-020-02043-2