Risk factors and outcomes of conversion in minimally invasive distal pancreatectomy: a systematic review

Purpose The reported conversion rates for minimally invasive distal pancreatectomy (MIDP) range widely from 2 to 38%. The identification of risk factors for conversion may help surgeons during preoperative planning and patient counseling. Moreover, the impact of conversion on outcomes of MIDP is unk...

Full description

Saved in:
Bibliographic Details
Published in:Langenbeck's archives of surgery 2021-05, Vol.406 (3), p.597-605
Main Authors: Balduzzi, A., van der Heijde, N., Alseidi, A., Dokmak, S., Kendrick, M. L., Polanco, P. M., Sandford, D. E., Shrikhande, S. V., Vollmer, C. M., Wang, S. E., Zeh, H. J., Hilal, M. Abu, Asbun, H. J., Besselink, M. G.
Format: Article
Language:English
Subjects:
Abdominal Surgery
Cardiac Surgery
General Surgery
Medicine
Medicine & Public Health
Systematic Reviews and Meta-analyses
Thoracic Surgery
Traumatic Surgery
Vascular Surgery
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Purpose The reported conversion rates for minimally invasive distal pancreatectomy (MIDP) range widely from 2 to 38%. The identification of risk factors for conversion may help surgeons during preoperative planning and patient counseling. Moreover, the impact of conversion on outcomes of MIDP is unknown. Methods A systematic review was conducted as part of the 2019 Miami International Evidence-Based Guidelines on Minimally Invasive Pancreas Resection (IG-MIPR). The PubMed, Cochrane, and Embase databases were searched for studies concerning conversion to open surgery in MIDP. Results Of the 828 studies screened, eight met the eligibility criteria, resulting in a combined dataset including 2592 patients after MIDP. The overall conversion rate was 17.1% (range 13.0–32.7%) with heterogeneity between studies associated with the definition of conversion adopted. Only one study divided conversion into elective and emergency conversion. The main indications for conversion were vascular involvement (23.7%), concern for oncological radicality (21.9%), and bleeding (18.9%). The reported risk factors for conversion included a malignancy as an indication for surgery, the proximity of the tumor to vascular structures in preoperative imaging, higher BMI or visceral fat, and multi-organ resection or extended resection. Contrasting results were seen in terms of blood loss and length of stay in comparing converted MIDP and completed MIDP patients. Conclusion The identified risk factors for conversion from this study can be used for patient selection and counseling. Surgeon experience should be considered when contemplating MIDP for a complex patient. Future studies should divide conversion into elective and emergency conversion.
ISSN:1435-2443
1435-2451
DOI:10.1007/s00423-020-02043-2