Assessing the impact of conversion on outcomes of minimally invasive distal pancreatectomy and pancreatoduodenectomy.

Autor:	Beane JD; University of Pittsburgh Medical Center, Division of Surgical Oncology, Pittsburgh, PA, USA., Pitt HA; Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA., Dolejs SC; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA., Hogg ME; University of Pittsburgh Medical Center, Division of Surgical Oncology, Pittsburgh, PA, USA., Zeh HJ; University of Pittsburgh Medical Center, Division of Surgical Oncology, Pittsburgh, PA, USA., Zureikat AH; University of Pittsburgh Medical Center, Division of Surgical Oncology, Pittsburgh, PA, USA. Electronic address: zureikatah@upmc.edu.
Jazyk:	angličtina
Zdroj:	HPB : the official journal of the International Hepato Pancreato Biliary Association [HPB (Oxford)] 2018 Apr; Vol. 20 (4), pp. 356-363. Date of Electronic Publication: 2017 Nov 27.
DOI:	10.1016/j.hpb.2017.10.007
Abstrakt:	Background: Our aim was to compare outcomes of patients who undergo conversion to open during minimally invasive distal pancreatectomy (MI-DP) and pancreatoduodenectomy (MI-PD) to those completed in minimally invasive fashion, and to compare outcomes of minimally invasive completions and conversions to planned open pancreatectomy. Methods: Propensity scoring was used to compare outcomes of completed and converted cases from a national cohort, and multivariate regression analysis (MVA) was used to compare minimally invasive completions and conversions to planned open pancreatectomy. Results: MI-DP was performed in 43.0%. Conversions (20.2%) had increased morbidity (32.3 vs 42.0%), serious morbidity (11.1 vs 21.2%), and organ space infection (6.2 vs 14.2%). Outcomes of MI-DP conversions were comparable to open. MI-PD was performed in 6.1%. Conversions (25.2%) had increased organ space infection (10.9 vs 26.6%), blood transfusions (17.2 vs 42.2%), and clinically relevant pancreatic fistula (11.5 vs 28.1%). On MVA, conversion of MI-PD was associated with increased mortality (OR 2.84, 95% CI 1.09-7.42), post-operative percutaneous drain placement (OR 2.36, 95% CI 1.32-4.20), and blood transfusions (OR 1.85, 95% CI 1.07-3.21). Conclusion: Converted cases have increased morbidity compared to completions, and for patients undergoing PD, conversions may be associated with inferior outcomes compared to planned open cases. (Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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