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/m2 (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.
Conversion during Minimally Invasive Left Pancreatectomy / De Ponthaud, Charles; Nassar, Alexandra; Dokmak, Safi; Bertrand, Thibaud; De Martino, Julien; Pastier, Clément; Castel, Antoine; De Rosa, Raffaele; Boubaddi, Mehdi; Iben-Khayat, Abdallah; Giannone, Fabio; Jolly, Elsa; Garnier, Jonathan; Louis-Gaubert, Clément; Mazzotta, Alessandro D; André, Marie; Gagnière, Johan; Viennet, Manon; Souche, François-Régis; Kianmanesh, Reza; Lupinacci, Renato Micelli; Regimbeau, Jean-Marc; Paye, François; Addeo, Pietro; Laurent, Alexis; Vandermeulen, Morgan; Caiazzo, Robert; El Amrani, Mehdi; Tresallet, Christophe; Doussot, Alexandre; Brunel, Martin; Jouffret, Lionel; Pinto, Amandine; Valverde, Alain; Romero Vece, Rodolfo; Fara, Régis; Mahfouf, Samir; Darnis, Benjamin; Chamakhi, Amine; Thereaux, Jeremie; Lubrano, Jean; Girard, Edouard; Veziant, Julie; Birnbaum, David Jérémie; Danion, Jérôme; Corté, Helene; Zemour, Johanna; Piardi, Tullio; de Carbonnières, Anne; Ragot, Emilia; Zarzavadjian Le Bian, Alban; David, Patrice; Brunaud, Laurent; Lermite, Emilie; Chreim, Laura; Charlaix, Ana Lucia; Gugenheim, Jean; Schwarz, Lilian; Bigourdan, Jean Marc; Le Roy, Bertrand; Karam, Elias; Rhaiem, Rami; Fabre, Jean-Michel; Lequeu, Jean-Baptiste; Noirault, Marie; Ayav, Ahmet; Soubrane, Olivier; Regenet, Nicolas; Turrini, Olivier; Muscari, Fabrice; Pessaux, Patrick; Thébault, Baudouin; Laurent, Christophe; Sulpice, Laurent; Sauvanet, Alain; Fuks, David; Gaujoux, Sébastien; Null, Null. - In: ANNALS OF SURGERY. - ISSN 0003-4932. - (2025). [10.1097/sla.0000000000006685]
Conversion during Minimally Invasive Left Pancreatectomy
Mazzotta, Alessandro D;
2025
Abstract
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/m2 (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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
