Annals of Surgical Oncology

, Volume 24, Issue 12, pp 3725–3731 | Cite as

Conversion of Minimally Invasive Distal Pancreatectomy: Predictors and Outcomes

  • Ibrahim Nassour
  • Sam C. Wang
  • Matthew R. Porembka
  • Mathew M. Augustine
  • Adam C. Yopp
  • John C. Mansour
  • Rebecca M. Minter
  • Michael A. Choti
  • Patricio M. Polanco
Pancreatic Tumors



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


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).


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).


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.



The research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001105. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The authors thank Dave Primm for his help in editing this manuscript and Helen Mayo from the UT Southwestern Health Sciences Digital Library and Learning Center for assistance with literature searches. Rebecca M. Minter is the Alvin Baldwin Jr Chair in Surgery. Matthew R. Porembka is the Dedman Family Scholar in clinical care, and Sam C. Wang is a UT Southwestern Disease-Oriented Clinical Scholar.

Conflict of interest

The authors have no conflict of interest.


  1. 1.
    Røsok BI, de Rooij T, van Hilst J, et al. Minimally invasive distal pancreatectomy. HPB Oxford. 2017;19:205–214.PubMedGoogle Scholar
  2. 2.
    Mehrabi A, Hafezi M, Arvin J, et al. A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: it’s time to randomize. Surgery. 2015;157:45–55.CrossRefPubMedGoogle Scholar
  3. 3.
    Shakir M, Boone BA, Polanco PM, et al. The learning curve for robotic distal pancreatectomy: an analysis of outcomes of the first 100 consecutive cases at a high-volume pancreatic centre. HPB Oxford. 2015;17:580–6.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    de Rooij T, van Hilst J, Boerma D, et al. Impact of a nationwide training program in minimally invasive distal pancreatectomy (LAELAPS). Ann Surg. 2016;264:754–62.CrossRefPubMedGoogle Scholar
  5. 5.
    Sui CJ, Li B, Yang JM, Wang SJ, Zhou YM. Laparoscopic versus open distal pancreatectomy: a meta-analysis. Asian J Surg. 2012;35:1–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Lee SY, Allen PJ, Sadot E, et al. Distal pancreatectomy: a single institution’s experience in open, laparoscopic, and robotic approaches. J Am Coll Surg. 2015;220:18–27.CrossRefPubMedGoogle Scholar
  7. 7.
    Plotkin A, Ceppa EP, Zarzaur BL, Kilbane EM, Riall TS, Pitt HA. Reduced morbidity with minimally invasive distal pancreatectomy for pancreatic adenocarcinoma. HPB Oxford. 2017;19:279–85.CrossRefPubMedGoogle Scholar
  8. 8.
    Daouadi M, Zureikat AH, Zenati MS, et al. Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Ann Surg. 2013;257:128–32.CrossRefPubMedGoogle Scholar
  9. 9.
    Gavriilidis P, Lim C, Menahem B, Lahat E, Salloum C, Azoulay D. Robotic versus laparoscopic distal pancreatectomy: the first meta-analysis. HPB Oxford. 2016;18:567–74.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Goh BKP, Chan CY, Lee SY, et al. Factors associated with and consequences of open conversion after laparoscopic distal pancreatectomy: initial experience at a single institution. ANZ J Surg. 2016. doi: 10.1111/ans.13661.Google Scholar
  11. 11.
    American College of Surgeons. User Guide for the 2015 ACS NSQIP Procedure Targeted Participant Use Data File (PUF). Retrieved 12 December 2016 at
  12. 12.
    Jayaraman S, Gonen M, Brennan MF, et al. Laparoscopic distal pancreatectomy: evolution of a technique at a single institution. J Am Coll Surg. 2010;211:503–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Zureikat AH, Borrebach J, Pitt HA, et al. Minimally invasive hepatopancreatobiliary surgery in North America: an ACS-NSQIP analysis of predictors of conversion for laparoscopic and robotic pancreatectomy and hepatectomy. HPB Oxford. 2017:19(7):595–602.CrossRefPubMedGoogle Scholar
  14. 14.
    Kaafarani HM, Smith TS, Neumayer L, Berger DH, Depalma RG, Itani KM. Trends, outcomes, and predictors of open and conversion to open cholecystectomy in Veterans Health Administration hospitals. Am J Surg. 2010;200:32–40.CrossRefPubMedGoogle Scholar
  15. 15.
    Lipman JM, Claridge JA, Haridas M, Martin MD, Yao DC, Grimes KL, Malangoni MA. Preoperative findings predict conversion from laparoscopic to open cholecystectomy. Surgery. 2007;142:556–65.CrossRefPubMedGoogle Scholar
  16. 16.
    Sippey M, Grzybowski M, Manwaring ML, et al. Acute cholecystitis: risk factors for conversion to an open procedure. J Surg Res. 2015;199:357–61.CrossRefPubMedGoogle Scholar
  17. 17.
    Bhama AR, Charlton ME, Schmitt MB, Cromwell JW, Byrn JC. Factors associated with conversion from laparoscopic to open colectomy using the National Surgical Quality Improvement Program (NSQIP) database. Colorectal Dis. 2015;17:257–64.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Nassour I, Polanco PM. Minimally invasive liver surgery for hepatic colorectal metastases. Curr Colorectal Cancer Rep. 2016;12:103–12.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Chen S, Zhan Q, Chen J-Z, et al. Robotic approach improves spleen-preserving rate and shortens postoperative hospital stay of laparoscopic distal pancreatectomy: a matched cohort study. Surg Endosc. 2015;29:3507–18.CrossRefPubMedGoogle Scholar
  20. 20.
    Duran H, Ielpo B, Caruso R, et al. Does robotic distal pancreatectomy surgery offer similar results as laparoscopic and open approach? A comparative study from a single medical center. Int J Med Robotics Comput Assist Surg. 2014;10:280–5.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Ibrahim Nassour
    • 1
  • Sam C. Wang
    • 1
  • Matthew R. Porembka
    • 1
  • Mathew M. Augustine
    • 1
  • Adam C. Yopp
    • 1
  • John C. Mansour
    • 1
  • Rebecca M. Minter
    • 1
  • Michael A. Choti
    • 1
  • Patricio M. Polanco
    • 1
    • 2
  1. 1.Division of Surgical OncologyUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Department of Veterans AffairsVA North Texas Health Care SystemDallasUSA

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