Factors Associated with and Impact of Open Conversion in Laparoscopic and Robotic Minor Liver Resections: An International Multicenter Study of 10,541 Patients.
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Saleh Mansour, Pascual Franco, Ghallab Mohammed, Wu Andrew G R, Chin Ken-Min, Ratti Francesca, Giglio Mariano Cesare, Garatti Marco, Nghia Phan Phuoc, Kato Yutaro, Lim Chetana, Herman Paulo, Coelho Fabricio Ferreira, Schmelzle Moritz, Pratschke Johann, Aghayan Davit L, Liu Qiu, Marino Marco V, Belli Andrea, Chiow Adrian K H, Sucandy Iswanto, Ivanecz Arpad, Di Benedetto Fabrizio, Choi Sung Hoon, Lee Jae Hoon, Park James O, Prieto Mikel, Guzman Yoelimar, Fondevila Constantino, Efanov Mikhail, Rotellar Fernando, Choi Gi-Hong, Robles-Campos Ricardo, Kadam Prashant, Sutcliffe Robert P, Troisi Roberto I, Tang Chung Ngai, Chong Charing C, D'Hondt Mathieu, Dalla Valle Bernardo, Ruzzenente Andrea, Kingham T Peter, Scatton Olivier, Liu Rong, Mejia Alejandro, Mishima Kohei, Wakabayashi Go, Lopez-Ben Santiago, Wang Xiaoying, Ferrero Alessandro, Ettorre Giuseppe Maria, Vivarelli Marco, Mazzaferro Vincenzo, Giuliante Felice, Yong Chee Chien, Yin Mengqiu, Monden Kazuteru, Geller David, Chen Kuo-Hsin, Sugioka Atsushi, Edwin Bjørn, Cheung Tan-To, Long Tran Cong Duy, Abu Hilal Mohammad, Aldrighetti Luca, Soubrane Olivier, Fuks David, Han Ho-Seong, Cherqui Daniel, Goh Brian K P, International Robotic and Laparoscopic Liver Resection Study Group Investigators
Аннотация
METHODS: This is a post-hoc analysis of 20,019 patients who underwent RLR and LLR across 50 international centers between 2004-2020. Risk factors for and perioperative outcomes of open conversion were analysed. Multivariate and propensity score-matched analysis were performed to control for confounding factors.
RESULTS: Finally, 10,541 patients undergoing either laparoscopic (LLR; 89.1%) or robotic (RLR; 10.9%) minor liver resections (wedge resections, segmentectomies) were included. Multivariate analysis identified LLR, earlier period of MILR, malignant pathology, cirrhosis, portal hypertension, previous abdominal surgery, larger tumor size, and posterosuperior location as significant independent predictors of open conversion. The most common reason for conversion was technical issues (44.7%), followed by bleeding (27.2%), and oncological reasons (22.3%). After propensity score matching (PSM) of baseline characteristics, patients requiring open conversion had poorer outcomes compared with successful MILR cases as evidenced by longer operative times, more blood loss, higher requirement for perioperative transfusion, longer duration of hospitalization and higher morbidity, reoperation, and 90-day mortality rates.
CONCLUSIONS: Multiple risk factors were associated with conversion of MILR even for minor hepatectomies, and open conversion was associated with significantly poorer perioperative outcomes.