Conversion during Minimally Invasive Left Pancreatectomy: A Nationwide Study of Causes and Consequences.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
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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, AFC- study group
Аннотация
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.