Sanne Lof1,2, Maarten Korrel3, Jony van Hilst3, Alma L Moekotte1, Claudio Bassi4, Giovanni Butturini5, Ugo Boggi6, Safi Dokmak7, Bjørn Edwin8, Massimo Falconi9, David Fuks10, Matteo de Pastena4, Alessandro Zerbi11, Marc G Besselink3, Mohammed Abu Hilal1,2. 1. Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom. 2. Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy. 3. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands. 4. Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy. 5. Department of Surgery, Pederzoli Hospital, Peschiera, Italy. 6. Department of Surgery, Universitá di Pisa, Pisa, Italy. 7. Department of Surgery, Hospital of Beaujon, Clichy, France. 8. The Intervention Centre, Department of HPB Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway. 9. Pancreatic Department of Surgery, San Raffaele Hospital, Università "Vita e Salute", Cologno Monzese, Italy. 10. Département de Chirurgie Digestive, Oncologique et Métabolique, Institut Mutualiste Montsouris, Paris, France. 11. Department of Surgery, Humanitas University Hospital, Milan, Italy.
Abstract
OBJECTIVE: The aim of this study was to investigate the impact of conversion during minimally invasive distal pancreatectomy (MIDP) for pancreatic ductal adenocarcinoma (PDAC) on outcome by a propensity-matched comparison with open distal pancreatectomy (ODP). BACKGROUND: MIDP is associated with faster recovery as compared with ODP. The high conversion rate (15%-25%) in patients with PDAC, however, is worrisome and may negatively influence outcome. METHODS: A post hoc analysis of a retrospective cohort including distal pancreatectomies for PDAC from 34 centers in 11 countries. Patients requiring conversion were matched, using propensity scores, to ODP procedures (1:2 ratio). Indications for conversion were classified as elective conversions (eg, vascular involvement) or emergency conversions (eg, bleeding). RESULTS: Among 1212 distal pancreatectomies for PDAC, 345 patients underwent MIDP, with 68 (19.7%) conversions, mostly elective (n = 46, 67.6%). Vascular resection (other than splenic vessels) was required in 19.1% of the converted procedures. After matching (61 MIDP-converted vs 122 ODP), conversion did not affect R-status, recurrence of cancer, nor overall survival. However, emergency conversion was associated with increased overall morbidity (61.9% vs 31.1%, P= 0.007) and a trend to worse oncological outcome compared with ODP. Elective conversion was associated with comparable overall morbidity. CONCLUSIONS: Elective conversion in MIDP for PDAC was associated with comparable short-term and oncological outcomes in comparison with ODP. However, emergency conversions were associated with worse both short- and long-term outcomes, and should be prevented by careful patient selection, awareness of surgeons' learning curve, and consideration of early conversion when unexpected intraoperative findings are encountered.
OBJECTIVE: The aim of this study was to investigate the impact of conversion during minimally invasive distal pancreatectomy (MIDP) for pancreatic ductal adenocarcinoma (PDAC) on outcome by a propensity-matched comparison with open distal pancreatectomy (ODP). BACKGROUND: MIDP is associated with faster recovery as compared with ODP. The high conversion rate (15%-25%) in patients with PDAC, however, is worrisome and may negatively influence outcome. METHODS: A post hoc analysis of a retrospective cohort including distal pancreatectomies for PDAC from 34 centers in 11 countries. Patients requiring conversion were matched, using propensity scores, to ODP procedures (1:2 ratio). Indications for conversion were classified as elective conversions (eg, vascular involvement) or emergency conversions (eg, bleeding). RESULTS: Among 1212 distal pancreatectomies for PDAC, 345 patients underwent MIDP, with 68 (19.7%) conversions, mostly elective (n = 46, 67.6%). Vascular resection (other than splenic vessels) was required in 19.1% of the converted procedures. After matching (61 MIDP-converted vs 122 ODP), conversion did not affect R-status, recurrence of cancer, nor overall survival. However, emergency conversion was associated with increased overall morbidity (61.9% vs 31.1%, P= 0.007) and a trend to worse oncological outcome compared with ODP. Elective conversion was associated with comparable overall morbidity. CONCLUSIONS: Elective conversion in MIDP for PDAC was associated with comparable short-term and oncological outcomes in comparison with ODP. However, emergency conversions were associated with worse both short- and long-term outcomes, and should be prevented by careful patient selection, awareness of surgeons' learning curve, and consideration of early conversion when unexpected intraoperative findings are encountered.
Authors: A Balduzzi; N van der Heijde; A Alseidi; S Dokmak; M L Kendrick; P M Polanco; D E Sandford; S V Shrikhande; C M Vollmer; S E Wang; H J Zeh; M Abu Hilal; H J Asbun; M G Besselink Journal: Langenbecks Arch Surg Date: 2020-12-10 Impact factor: 3.445
Authors: Riccardo Casadei; Claudio Ricci; Carlo Ingaldi; Laura Alberici; Maria Chiara Vaccaro; Elisa Galasso; Francesco Minni Journal: World J Surg Date: 2020-10-15 Impact factor: 3.352