Incidence, Causes, and Outcomes of Conversion to Open Surgery During Minimally Invasive Left Pancreatectomy: A Prospective Multicenter Study.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Gomez Ismael, C Villodre, B Hernández-Roca, Jj Rubio-García, Busquets Juli, Secanella Luis, Peláez Nuria, Alkorta Maialen, De Ariño Hervas Itziar, Achalandabaso Mᵃ Mar, Toledo Enrique, Rotellar Fernando, Martí-Cruchaga Pablo, Gómez-Bravo Miguel Ángel, Suárez Gonzalo, Garcés-Albir Marina, Sabater Luis, García Gabriel, Alcalá Francisco Javier, Asensio Enrique, Pacheco David, Cugat Esteban, Espín Francisco, Galófre María, Sánchez Belinda, Santoyo Julio, Calvo Jorge, Loinaz Carmelo, García Maribel, Sánchez-Cabús Santiago, Martín Belén, Blanco Gerardo, Jaén-Torrejimeno Isabel, Domingo Carlos, Payá Carmen, González Carmen, Ruiz Sandra, López-Andújar Rafael, Ballester Cristina, Vico Ana Belén, Zambudio Natalia, Estévez Sergio, Nogueira-Sixto Manuel, Miota José Ignacio, Conde Belén, Suárez Miguel Ángel, Rúa Jorge Roldán de la, Blanco Angelica, González Manuel, González Pilar Elena, Reyes Betsabé, Ben Santiago López, Tió Berta, Mínguez Javier, Lasa Inmaculada, Miyar Alberto, Solar Lorena, Burdio Fernando, Ielpo Benedetto, Carabias Alberto, Paloma María, Escartín Alfredo, Vela Fulthon, Marqués Elia, Pérez Adelino, Palomares Gloria, Calvo Antonio, Castell José Tomás, Castro María Jesús, Manzanares M Carmen, Artigues Enrique, Blas Juan Luis, Díez Luis, Calero Alicia, Quiñones José E, Rodríguez Mario, Serradilla-Martín Mario, Alcázar Cándido, Jm Ramia
Аннотация
METHODS: The SPANDISPAN Project is a prospective, multicenter study conducted at 41 Spanish hospitals from February 2022 to January 2023. Patients were divided into conversion and nonconversion groups to identify predictors using univariate and multivariate logistic regression models.
RESULTS: Of 313 recorded left pancreatectomies, 217 (69.3%) were MILP procedures. The conversion rate was 10.6%. Reasons for conversion included hemorrhage (60.9%) and intraoperative technical difficulties (39.1%). Multivariable analysis identified intraoperative blood loss (OR 1.65 per 100-mL increment; p < 0.001) and intraoperative transfusion (OR 7.777; p = 0.012) as independent intraoperative correlates of conversion, reflecting the bleeding-related process leading to conversion rather than preoperative predictors available for case selection. Low center volume was associated with a higher conversion rate in univariable analysis (14.5% vs. 6%; p = 0.042) with a nonsignificant protective trend for high-volume centers after multivariable adjustment (OR 0.339; p = 0.075). Although patients who required conversion had longer operative times and hospital stays, there were no significant differences in major complications, postoperative pancreatic fistula, or mortality between the groups.
CONCLUSIONS: Conversion to open surgery during MILP is primarily driven by intraoperative bleeding-related events rather than by preoperative patient or tumor characteristics. Treatment at a high-volume center was associated with a lower conversion rate, although this trend did not reach significance after multivariable adjustment. Conversion was not associated with a significant increase in major morbidity or mortality in this cohort, supporting its use as a proactive safety measure rather than a surgical failure, although the limited number of conversion events warrants a cautious interpretation of this negative finding.