• Mark C Halls, Federica Cipriani, Giammauro Berardi, Leonid Barkhatov, Panagiotis Lainas, Mohammed Alzoubi, Mathieu D'Hondt, Fernando Rotellar, Ibrahim Dagher, Luca Aldrighetti, Roberto I Troisi, Bjorn Edwin, and Mohammed Abu Hilal.
• University Hospital Southampton, Southampton, UK.
• Ann. Surg. 2018 Dec 1; 268 (6): 1051-1057.

ObjectiveTo investigate the risk factors for conversion during laparoscopic liver resection and its effect on patient outcome in a large cohort of patients. Additional analysis of outcomes in patients who required conversion for unfavorable intraoperative findings and conversion for unfavorable intraoperative events will be performed to establish if the cause of conversion effects outcome.Summary Background DataMultiple previous studies demonstrate that laparoscopic liver surgery reduces intraoperative blood loss, hospital stay, and morbidity while maintaining comparable oncological and survival outcomes when compared with open liver resections. However, limited information is available regarding the possible sequelae of conversion to open surgery, especially with regards to cause of conversion.MethodsA retrospective analysis of 2861 cases from prospectively maintained databases of 7 tertiary liver centers across Europe was performed.ResultsNeo-adjuvant chemotherapy, previous liver resection(s), resections for malignant lesions, postero-superior location, and the extent of the resection are associated with an increased risk of conversion. Patients who require conversion have longer operations with higher blood loss; a longer HDU and total hospital stay, increased frequency and severity of complications and higher 30- and 90-day mortality. Patients who had an elective conversion for an unfavorable intraoperative finding had better outcomes than patients who had an emergency conversion secondary to an unfavorable intraoperative event in terms of HDU and total hospital stay, severity of complication, and 90-day mortality.ConclusionsOur study highlights the risk factors for conversion and suggests that conversion for unfavorable intraoperative events is associated with worse outcomes.

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