Risk factors and outcomes of conversion in minimally invasive distal pancreatectomy: a systematic review
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SYSTEMATIC REVIEWS AND META-ANALYSES
Risk factors and outcomes of conversion in minimally invasive distal pancreatectomy: a systematic review A. Balduzzi 1 & N. van der Heijde 2,3 & A. Alseidi 4 & S. Dokmak 5 & M. L. Kendrick 6 & P. M. Polanco 7 & D. E. Sandford 8 & S. V. Shrikhande 9 & C. M. Vollmer 10 & S. E. Wang 11 & H. J. Zeh 12 & M. Abu Hilal 2,13 & H. J. Asbun 14 & M. G. Besselink 3 & on behalf of the International Evidence-based Guidelines of Minimally Invasive Pancreas Resection Group Received: 30 September 2020 / Accepted: 20 November 2020 # The Author(s) 2020
Abstract Purpose The reported conversion rates for minimally invasive distal pancreatectomy (MIDP) range widely from 2 to 38%. The identification of risk factors for conversion may help surgeons during preoperative planning and patient counseling. Moreover, the impact of conversion on outcomes of MIDP is unknown. Methods A systematic review was conducted as part of the 2019 Miami International Evidence-Based Guidelines on Minimally Invasive Pancreas Resection (IG-MIPR). The PubMed, Cochrane, and Embase databases were searched for studies concerning conversion to open surgery in MIDP. Results Of the 828 studies screened, eight met the eligibility criteria, resulting in a combined dataset including 2592 patients after MIDP. The overall conversion rate was 17.1% (range 13.0–32.7%) with heterogeneity between studies associated with the definition of conversion adopted. Only one study divided conversion into elective and emergency conversion. The main indications for conversion were vascular involvement (23.7%), concern for oncological radicality (21.9%), and bleeding (18.9%). The reported risk factors for conversion included a malignancy as an indication for surgery, the proximity of the tumor to vascular structures in preoperative imaging, higher BMI or visceral fat, and multi-organ resection or extended resection. Contrasting results were seen in terms of blood loss and length of stay in comparing converted MIDP and completed MIDP patients. Conclusion The identified risk factors for conversion from this study can be used for patient selection and counseling. Surgeon experience should be considered when contemplating MIDP for a complex patient. Future studies should divide conversion into elective and emergency conversion. A. Balduzzi and N. van der Heijde shared first authorship M. Abu Hilal, H. Asbun and M. G. Besselink shared senior authorship * M. G. Besselink [email protected] M. Abu Hilal [email protected] H. J. Asbun [email protected] 1
Department of Surgery, University Hospital, Verona, Italy
2
Department of Surgery, Southampton University Hospital, Southampton, UK
3
Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
4
Department of Surgery, University of California, San Francisco, CA, USA
5
Department of Surgery, Beaujon Hospital, Paris, France
6
Department of Surgery, Mayo Clinic, Rochester, MN, USA
7
Department of Surgery, UT Southwestern Medic
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