Advertisement

Laparoscopic distal pancreatectomy: which factors are related to open conversion? Lessons learned from 68 consecutive procedures in a high-volume pancreatic center

  • Riccardo Casadei
  • Claudio Ricci
  • Carlo Alberto Pacilio
  • Carlo Ingaldi
  • Giovanni Taffurelli
  • Francesco Minni
Article
  • 94 Downloads

Abstract

Background

Laparoscopic distal pancreatectomy represents a difficult surgical procedure with an high conversion rate to open procedure. The factors related to its difficulty and conversion to open distal pancreatectomy were rarely reported. The aim of the present study was to identify which factors are related to conversion from laparoscopic to open distal pancreatectomy.

Methods

A retrospective study of a prospective database of 68 patients who underwent laparoscopic distal pancreatectomy was conducted at a high-volume center by pancreatic surgeons experienced with laparoscopic surgery. Pre-intra and postoperative data were collected. Patients who completed a laparoscopic distal pancreatectomy were compared with those who needed a conversion to the open approach as regard demographic, clinical, radiological, and surgical data. Univariate and multivariate analyses were carried out.

Results

Univariate analysis suggested that the site of the lesion, the extension of pancreatic resection, and the requirement for an extended procedure to adjacent organs were significantly associated with the risk of conversion to the open approach. Multivariate analysis showed that only the extension of the pancreatic resection (subtotal pancreatectomy) was significantly related to the odds of conversion [odds ratio (OR) 19.5; 95% confidence interval (CI) 1.1–32.3; P = 0.038]. Preoperative suspicion of malignancy differed between the two groups; however, this difference did not reach statistical significance (P = 0.078).

Conclusions

Despite the limitations of the study, only the extension of pancreatic resection seemed to be the main factor related to conversion during laparoscopic distal pancreatectomy.

Keywords

Pancreas Laparoscopic distal pancreatectomy Open distal pancreatectomy Conversion Pancreatic resection 

Notes

Compliance with ethical standards

Disclosures

Riccardo Casadei, Claudio Ricci, Carlo Alberto Pacilio, Carlo Ingaldi, Giovanni Taffurelli, and Francesco Minni declare that they have no conflict of interest.

References

  1. 1.
    Venkat R, Edil BH, Schulick RD, Lidor AO, Makary MA, Wolfgang CL (2012) Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg 255(6):1048–1059CrossRefPubMedGoogle Scholar
  2. 2.
    Pericleous S, Middleton N, McKay SC, Bowers KA, Hutchins RR (2012) Systematic review and meta-analysis of case-matched studies comparing open and laparoscopic distal pancreatectomy: is it a safe procedure? Pancreas 41(7):993–1000CrossRefPubMedGoogle Scholar
  3. 3.
    Mehrabi A, Hafezi M, Arvin J, Esmaeilzadeh M, Garoussi C, Emami G et al (2015) A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: it’s time to randomize. Surgery 157(1):45–55CrossRefPubMedGoogle Scholar
  4. 4.
    Ricci C, Casadei R, Lazzarini E, D’Ambra M, Buscemi S, Pacilio CA et al (2014) Laparoscopic distal pancreatectomy in Italy: a systematic review and meta-analysis. Hepatobiliary Pancreat Dis Int 13(5):458–463CrossRefPubMedGoogle Scholar
  5. 5.
    Ricci C, Casadei R, Taffurelli G, Toscano F, Pacilio CA, Bogoni S et al (2015) Laparoscopic versus open distal pancreatectomy for ductal adenocarcinoma: a systematic review and meta-analysis. J Gastrointest Surg 19(4):770–781CrossRefPubMedGoogle Scholar
  6. 6.
    Ricci C, Casadei R, Taffurelli G, Pacilio CA, Minni F (2016) Laparoscopic distal pancreatectomy: many meta-analyses, few certainties. Updates Surg 68(3):225–234CrossRefPubMedGoogle Scholar
  7. 7.
    Riviere D, Gurusamy KS, Kooby DA, Vollmer CM, Besselink MG, Davidson BR et al (2016) Laparoscopic versus open distal pancreatectomy for pancreatic cancer. Cochrane Database Syst Rev 4:CD011391.  https://doi.org/10.1002/14651858.CD011391.pub2 PubMedGoogle Scholar
  8. 8.
    Abu Hilal M, Richardson JR, de Rooij T, Dimovska E, Al-Saati H, Besselink MG (2016) Laparoscopic radical ‘no-touch’ left pancreatosplenectomy for pancreatic ductal adenocarcinoma: technique and results. Surg Endosc 30(9):3830–3838CrossRefPubMedGoogle Scholar
  9. 9.
    Bhama AR, Charlton ME, Schmitt MB, Cromwell JW, Byrn JC (2015) Factors associated with conversion from laparoscopic to open colectomy using the National Surgical Quality Improvement Program (NSQIP) database. Colorectal Dis 17(3):257–264CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Gaujoux S, Bonnet S, Leconte M, Zohar S, Bertherat J, Bertagna X et al (2011) Risk factors for conversion and complications after unilateral laparoscopic adrenalectomy. Br J Surg 98:1392–1399CrossRefPubMedGoogle Scholar
  11. 11.
    Goitein D, Mintz Y, Gross D, Reissman P (2004) Laparoscopic adrenalectomy: ascending the learning curve. Surg Endosc 18:771–773CrossRefPubMedGoogle Scholar
  12. 12.
    Choi DH, Jeong WK, Lim SW, Chung TS, Park JI, Lim SB et al (2008) Learning curves for laparoscopic sigmoidectomy used to manage curable sigmoid colon cancer: single-institute, three-surgeon experience. Surg Endosc 23:622–628CrossRefPubMedGoogle Scholar
  13. 13.
    Braga M, Ridolfi C, Balzano G, Castoldi R, Pecorelli N, Di Carlo V (2012) Learning curve for laparoscopic distal pancreatectomy in a high-volume hospital. Updates Surg 64:179–183CrossRefPubMedGoogle Scholar
  14. 14.
    Ricci C, Casadei R, Buscemi S, Taffurelli G, D’Ambra M, Pacilio CA et al (2015) Laparoscopic distal pancreatectomy: what factors are related to the learning curve? Surg Today 45(1):50–56CrossRefPubMedGoogle Scholar
  15. 15.
    Daouadi M, Zureikat AH, Zenati MS, Choudry H, Tsung A, Bartlett DL et al (2013) Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Ann Surg 257(1):128–132CrossRefPubMedGoogle Scholar
  16. 16.
    Lee SY, Allen PJ, Sadot E, D’Angelica MI, DeMatteo RP, Fong Y et al (2015) Distal pancreatectomy: a single institution’s experience in open, laparoscopic, and robotic approaches. Am Coll Surg 220(1):18–27CrossRefGoogle Scholar
  17. 17.
    Goh BK, Chan CY, Lee SY, Chan WH, Cheow PC, Chow PK et al (2016) Factors associated with and consequences of open conversion after laparoscopic distal pancreatectomy: initial experience at a single institution. ANZ J Surg.  https://doi.org/10.1111/ans.13661 Google Scholar
  18. 18.
    Hua Y, Javed AA, Burkhart RA, Makary MA, Weiss MJ, Wolfgang CL, He J (2017) Preoperative risk factors for conversion and learning curve of minimally invasive distal pancreatectomy. Surgery 162:1040–1047CrossRefPubMedGoogle Scholar
  19. 19.
    Casadei R, Ricci C, D’Ambra M, Marrano N, Alagna V, Rega D et al (2010) Laparoscopic versus open distal pancreatectomy in pancreatic tumours: a case-control study. Updates Surg 62(3–4):171–174CrossRefPubMedGoogle Scholar
  20. 20.
    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196CrossRefPubMedGoogle Scholar
  21. 21.
    Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13CrossRefPubMedGoogle Scholar
  22. 22.
    Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ et al (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142:20–25CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Riccardo Casadei
    • 1
    • 2
  • Claudio Ricci
    • 1
  • Carlo Alberto Pacilio
    • 1
  • Carlo Ingaldi
    • 1
  • Giovanni Taffurelli
    • 1
  • Francesco Minni
    • 1
  1. 1.Dipartimento di Scienze Mediche e Chirurgiche (DIMEC)Alma Mater Studiorum, Università di Bologna, Policlinico S.Orsola-MalpighiBolognaItaly
  2. 2.Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Chirurgia Generale-Prof. MinniAlma Mater Studiorum, Università di Bologna, Policlinico S.Orsola-MalpighiBolognaItaly

Personalised recommendations