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Conversion during Minimally Invasive Left Pancreatectomy
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Edité par CCSD ; Lippincott, Williams & Wilkins -
International audience. Objectives: To identify risk factors for conversion, develop a predictive Conversion Risk Score (CRS), and assess the association between conversion and severe postoperative complications. Background: Conversion occurs in 15-30% of minimally invasive left pancreatectomies (MILP). Risk factors and potential negative impacts on postoperative outcomes are poorly described. Methods: Retrospective, nationwide, multicenter study including all MILP (laparoscopy and robot) performed between 2010 and 2021. Risk factors for conversion were identified by multivariate mixed model, and a CRS was developed on a “training-set” and validated (calibration diagrams and ROC curves) on a “validation-set.” The association between severe complications and conversion was assessed using a propensity score based on the main risk factors for severe complications: age, sex, BMI, ASA score, tumor malignancy, multi-organ resection, operative duration, blood loss, splenectomy. Results: 2104 patients included from 55 centers. Conversion occurred in 15.6% of MILP. Its risk factors were male sex (OR=1.67; P =0.048), BMI≥25 kg/m 2 (OR=2.15; P =0.004), history of laparotomy (OR=2.9; P <0.001), initial pancreatitis (OR=3.58; P =0.007), tumor size≥40 mm (OR=2.12; P =0.003), planned splenectomy (OR=2.63; P <0.001), unplanned splenectomy (OR=4.05; P =0.028), portal vein resection (OR=36.3; P =0.002), multi-organ resection (OR=12.97; P <0.001). A predictive CRS was created based only on preoperatively available variables (the first six), with scores ranging from 0 to 7, corresponding to a conversion risk of 2% to 100%. No association was observed with tumor malignancy, robotic approach, or pancreatectomy volume. Conversion was significantly associated with severe complications [OR=1.80(1.16-2.54)], independent of other risk factors for complications. Conclusions: Conversion during MILP can be predicted by CRS, aiding surgeons in decision-making, given its significant association with severe complications.
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