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Circumstances and implications of conversion from minimally invasive to open liver resection: a multi-center analysis from the AMILES registry

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Abstract

Background

Minimally invasive approaches to liver resection (MILR) are associated with favorable outcomes. The aim of this study was to determine the implications of conversion to an open procedure on perioperative outcomes.

Methods

Patients who underwent MILR at 10 North American institutions were identified from the Americas Minimally Invasive Liver Resection (AMILES) database. Outcomes of patients who required conversion were compared to those who did not. Additionally, outcomes after conversion due to unfavorable findings (poor visualization/access, lack of progress, disease extent) versus intraoperative events (bleeding, injury, cardiopulmonary instability) were compared.

Results

Of 1675 patients who underwent MILR, 102 (6.1%) required conversion. Conversion rate ranged from 4.4% for left lateral sectionectomy to 10% for right hepatectomy. The primary reason for conversion was unfavorable findings in 67 patients (66%) and intraoperative adverse events in 35 patients (34%). By multivariable analysis, major resection, cirrhosis, prior liver surgery, and tumor proximity to major vessels were identified as risk factors for conversion (p < 0.05). Patients who required conversion had higher blood loss, transfusion requirements, operative time, and length of stay, (p < 0.05). They also had higher major complication rates (23% vs. 5.2%, p < 0.001) and 30-day mortality (8.8% vs. 1.3%, p < 0.001). When compared to those who required conversion due to unfavorable findings, patients who required conversion due to intraoperative adverse events had significantly higher major complication rates (43% vs. 14%, p = 0.012) and 30-day mortality (20% vs. 3.0%, p = 0.007).

Conclusions

Conversion from MILR to open surgery is associated with increased perioperative morbidity and mortality. Conversion due to intraoperative adverse events is rare but associated with significantly higher complication and mortality rates, while conversion due to unfavorable findings is associated with similar outcomes as planned open resection. High-risk patients may benefit from early conversion in a controlled fashion if difficulties are encountered or anticipated.

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Acknowledgements

Participating Investigators / AMILES Group Members. Thimoty Bourdeau, Christine Chung, Deborah Conn, John Martinie, Pierce Paterakos, Leyo Ruo, Samer Tohme, Dionisios Vrochides, Jaeyun Wang.

Funding

No funding from external sources was received for this project.

Author information

Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA

    Hallbera Gudmundsdottir, Guido Fiorentini, Susanne G. Warner & Sean P. Cleary

  2. Virginia Mason Medical Center, Seattle, WA, USA

    Yasmin Essaji, W. Scott Helton & Adnan Alseidi

  3. McMaster University, Hamilton, ON, Canada

    Daniel D’Souza & Pablo E. Serrano

  4. ProMedica Health System, Toledo, OH, USA

    Tania Torres-Ruiz & Kerri A. Simo

  5. University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    David A. Geller

  6. Northshore University HealthSystem, Evanston, IL, USA

    Melissa E. Hogg

  7. Atrium Health-Carolinas Medical Center, Charlotte, NC, USA

    David A. Iannitti

  8. Allina Health Cancer Institute, Minneapolis, MN, USA

    Ashwin S. Kamath

  9. Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Edwin O. Onkendi

  10. AdventHealth Tampa, Tampa, FL, USA

    Iswanto Sucandy

  11. University of California San Francisco, San Francisco, CA, USA

    Adnan Alseidi

Authors
  1. Hallbera Gudmundsdottir
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  2. Guido Fiorentini
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  6. David A. Geller
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  7. W. Scott Helton
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  8. Melissa E. Hogg
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  15. Susanne G. Warner
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  17. Sean P. Cleary
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Consortia

AMILES Group

  • Thimoty Bourdeau
  • , Christine Chung
  • , Deborah Conn
  • , John Martinie
  • , Pierce Paterakos
  • , Leyo Ruo
  • , Samer Tohme
  • , Dionisios Vrochides
  •  & Jaeyun Wang

Corresponding author

Correspondence to Sean P. Cleary.

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Disclosures

Hallbera Gudmundsdottir, Guido Fiorentini, Yasmin Essaji, Daniel D’Souza, Tania Torres-Ruiz, David A. Geller, W. Scott Helton, Melissa Hogg, David A. Iannitti, Ashwin Kamath, Edwin O. Onkendi, Pablo E. Serrano, Kerri A. Simo, Iswanto Sucandy, Susanne G. Warner, Adnan Alseidi, and Sean P. Cleary have no conflicts of interest or financial ties to disclose.

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The members of the AMILES Group listed in acknowledgements.

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Gudmundsdottir, H., Fiorentini, G., Essaji, Y. et al. Circumstances and implications of conversion from minimally invasive to open liver resection: a multi-center analysis from the AMILES registry. Surg Endosc 37, 9201–9207 (2023). https://doi.org/10.1007/s00464-023-10431-0

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