• Annals of surgery · Dec 2021

    Multicenter Study

    Outcomes of Elective and Emergency Conversion in Minimally Invasive Distal Pancreatectomy for Pancreatic Ductal Adenocarcinoma: An International Multicenter Propensity Score-matched Study.

    • Sanne Lof, Maarten Korrel, Jony van Hilst, Alma L Moekotte, Claudio Bassi, Giovanni Butturini, Ugo Boggi, Safi Dokmak, Bjørn Edwin, Massimo Falconi, David Fuks, Matteo de Pastena, Alessandro Zerbi, Marc G Besselink, Mohammed Abu Hilal, and European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS).
    • Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom.
    • Ann. Surg. 2021 Dec 1; 274 (6): e1001-e1007.

    ObjectiveThe aim of this study was to investigate the impact of conversion during minimally invasive distal pancreatectomy (MIDP) for pancreatic ductal adenocarcinoma (PDAC) on outcome by a propensity-matched comparison with open distal pancreatectomy (ODP).BackgroundMIDP is associated with faster recovery as compared with ODP. The high conversion rate (15%-25%) in patients with PDAC, however, is worrisome and may negatively influence outcome.MethodsA post hoc analysis of a retrospective cohort including distal pancreatectomies for PDAC from 34 centers in 11 countries. Patients requiring conversion were matched, using propensity scores, to ODP procedures (1:2 ratio). Indications for conversion were classified as elective conversions (eg, vascular involvement) or emergency conversions (eg, bleeding).ResultsAmong 1212 distal pancreatectomies for PDAC, 345 patients underwent MIDP, with 68 (19.7%) conversions, mostly elective (n = 46, 67.6%). Vascular resection (other than splenic vessels) was required in 19.1% of the converted procedures. After matching (61 MIDP-converted vs 122 ODP), conversion did not affect R-status, recurrence of cancer, nor overall survival. However, emergency conversion was associated with increased overall morbidity (61.9% vs 31.1%, P= 0.007) and a trend to worse oncological outcome compared with ODP. Elective conversion was associated with comparable overall morbidity.ConclusionsElective conversion in MIDP for PDAC was associated with comparable short-term and oncological outcomes in comparison with ODP. However, emergency conversions were associated with worse both short- and long-term outcomes, and should be prevented by careful patient selection, awareness of surgeons' learning curve, and consideration of early conversion when unexpected intraoperative findings are encountered.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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