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Predictors and outcomes of converted minimally invasive pancreaticoduodenectomy: a propensity score matched analysis

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Abstract

Background

Data-driven patient selection guidelines are not available to optimize outcomes in minimally invasive pancreaticoduodenectomy (MIPD). We aimed to define risk factors associated with conversion from MIPD to open PD and to determine the impact of conversion on post-operative outcomes.

Methods

We conducted a retrospective review of MIPD using NSQIP from 2014 to 2015. Propensity score was used to match patients who underwent completed MIPD to converted MIPD.

Results

467 patients were included: 375 (80.3%) MIPD and 92 (19.7%) converted. Converted patients were more often male (64% vs. 52%, p = 0.030), had higher rates of dyspnea (10% vs. 3%, p = 0.009), underwent more vascular (44% vs. 14%, p < 0.001) or multivisceral resection (19% vs. 6%, p = 0.0005), and were more likely attempted laparoscopically compared to robotically (76% vs. 51%, p < 0.001). Robotic approach was independently associated with reduced risk of conversion (OR 0.40, 95% CI 0.23–0.69), while male gender (OR 1.70, 95% CI 1.02–2.84), history of dyspnea (OR 3.85, 95% CI 1.49–9.96), vascular resection (OR 4.32, 95% CI 2.53–7.37), and multivisceral resection (OR 2.18, 95% CI 1.05–4.52) were associated with increased risk. Major complications were more common in converted patients (68% vs. 37%, p < 0.001). Converted patients had increased odds of non-home discharge (OR 3.25, 95% CI 1.06–9.97) and an associated increased length of stay of 3 days (95% CI 0.1–6.7).

Conclusion

Patients with a history of dyspnea or tumors requiring vascular or multivisceral resection were at increased risk of conversion, and the robotic platform was associated with a lower rate of conversion. Conversion was independently associated with increased overall complications, increased length of stay, and non-home discharge.

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Authors and Affiliations

  1. Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Caitlin A. Hester, Ibrahim Nassour, Mathew M. Augustine, John C. Mansour, Patricio M. Polanco, Matthew R. Porembka, Sam C. Wang, Adam C. Yopp & Herbert J. Zeh III

  2. Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Alana Christie

  3. Department of Veterans Affairs, VA North Texas Health Care System, Dallas, TX, USA

    Patricio M. Polanco

  4. Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Thomas H. Shoultz

  5. Department of Surgery, Division of Surgical Oncology, University of Wisconsin School of Medicine, 600 Highland Avenue, Madison, WI, USA

    Rebecca M. Minter

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  1. Caitlin A. Hester
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  2. Ibrahim Nassour
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  3. Alana Christie
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Correspondence to Rebecca M. Minter.

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Disclosures

Caitlin A. Hester, Ibrahim Nassour, Alana Christie, Mathew Augustine, John C. Mansour, Patricio M. Polanco, Matthew R. Porembka, Thomas H. Shoultz, Sam C. Wang, Adam C. Yopp, Herbert J. Zeh III, Rebecca M. Minter have no conflicts of interest or financial ties to disclose.

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Hester, C.A., Nassour, I., Christie, A. et al. Predictors and outcomes of converted minimally invasive pancreaticoduodenectomy: a propensity score matched analysis. Surg Endosc 34, 544–550 (2020). https://doi.org/10.1007/s00464-019-06792-0

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