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Conversion of Minimally Invasive Distal Pancreatectomy: Predictors and Outcomes

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Acknowledgements

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.

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Authors and Affiliations

  1. Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    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

  2. Department of Veterans Affairs, VA North Texas Health Care System, Dallas, TX, USA

    Patricio M. Polanco MD

Authors
  1. Ibrahim Nassour MD, MSCS
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  2. Sam C. Wang MD
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  3. Matthew R. Porembka MD
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  4. Mathew M. Augustine MD, PhD
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  5. Adam C. Yopp MD
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  6. John C. Mansour MD
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  7. Rebecca M. Minter MD
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  8. Michael A. Choti MD, MBA
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  9. Patricio M. Polanco MD
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Corresponding author

Correspondence to Patricio M. Polanco MD.

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Nassour, I., Wang, S.C., Porembka, M.R. et al. Conversion of Minimally Invasive Distal Pancreatectomy: Predictors and Outcomes. Ann Surg Oncol 24, 3725–3731 (2017). https://doi.org/10.1245/s10434-017-6062-5

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  • DOI: https://doi.org/10.1245/s10434-017-6062-5

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