TY - JOUR
T1 - Assessing the impact of conversion on outcomes of minimally invasive distal pancreatectomy and pancreatoduodenectomy
AU - Beane, Joal D.
AU - Pitt, Henry A.
AU - Dolejs, Scott C.
AU - Hogg, Melissa E.
AU - Zeh, Herbert J.
AU - Zureikat, Amer H.
N1 - Publisher Copyright:
© 2017 International Hepato-Pancreato-Biliary Association Inc.
PY - 2018/4
Y1 - 2018/4
N2 - Background: Our aim was to compare outcomes of patients who undergo conversion to open during minimally invasive distal pancreatectomy (MI-DP) and pancreatoduodenectomy (MI-PD) to those completed in minimally invasive fashion, and to compare outcomes of minimally invasive completions and conversions to planned open pancreatectomy. Methods: Propensity scoring was used to compare outcomes of completed and converted cases from a national cohort, and multivariate regression analysis (MVA) was used to compare minimally invasive completions and conversions to planned open pancreatectomy. Results: MI-DP was performed in 43.0%. Conversions (20.2%) had increased morbidity (32.3 vs 42.0%), serious morbidity (11.1 vs 21.2%), and organ space infection (6.2 vs 14.2%). Outcomes of MI-DP conversions were comparable to open. MI-PD was performed in 6.1%. Conversions (25.2%) had increased organ space infection (10.9 vs 26.6%), blood transfusions (17.2 vs 42.2%), and clinically relevant pancreatic fistula (11.5 vs 28.1%). On MVA, conversion of MI-PD was associated with increased mortality (OR 2.84, 95% CI 1.09–7.42), post-operative percutaneous drain placement (OR 2.36, 95% CI 1.32–4.20), and blood transfusions (OR 1.85, 95% CI 1.07–3.21). Conclusion: Converted cases have increased morbidity compared to completions, and for patients undergoing PD, conversions may be associated with inferior outcomes compared to planned open cases.
AB - Background: Our aim was to compare outcomes of patients who undergo conversion to open during minimally invasive distal pancreatectomy (MI-DP) and pancreatoduodenectomy (MI-PD) to those completed in minimally invasive fashion, and to compare outcomes of minimally invasive completions and conversions to planned open pancreatectomy. Methods: Propensity scoring was used to compare outcomes of completed and converted cases from a national cohort, and multivariate regression analysis (MVA) was used to compare minimally invasive completions and conversions to planned open pancreatectomy. Results: MI-DP was performed in 43.0%. Conversions (20.2%) had increased morbidity (32.3 vs 42.0%), serious morbidity (11.1 vs 21.2%), and organ space infection (6.2 vs 14.2%). Outcomes of MI-DP conversions were comparable to open. MI-PD was performed in 6.1%. Conversions (25.2%) had increased organ space infection (10.9 vs 26.6%), blood transfusions (17.2 vs 42.2%), and clinically relevant pancreatic fistula (11.5 vs 28.1%). On MVA, conversion of MI-PD was associated with increased mortality (OR 2.84, 95% CI 1.09–7.42), post-operative percutaneous drain placement (OR 2.36, 95% CI 1.32–4.20), and blood transfusions (OR 1.85, 95% CI 1.07–3.21). Conclusion: Converted cases have increased morbidity compared to completions, and for patients undergoing PD, conversions may be associated with inferior outcomes compared to planned open cases.
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U2 - 10.1016/j.hpb.2017.10.007
DO - 10.1016/j.hpb.2017.10.007
M3 - Article
C2 - 29191691
AN - SCOPUS:85035245866
SN - 1365-182X
VL - 20
SP - 356
EP - 363
JO - HPB
JF - HPB
IS - 4
ER -