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

Autor: Hester CA; Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA., Nassour I; Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA., Christie A; Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA., Augustine MM; Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA., Mansour JC; Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA., Polanco PM; Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA.; Department of Veterans Affairs, VA North Texas Health Care System, Dallas, TX, USA., Porembka MR; Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA., Shoultz TH; Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA., Wang SC; Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA., Yopp AC; Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA., Zeh HJ 3rd; Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA., Minter RM; Department of Surgery, Division of Surgical Oncology, University of Wisconsin School of Medicine, 600 Highland Avenue, Madison, WI, USA. minter@surgery.wisc.edu.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2020 Feb; Vol. 34 (2), pp. 544-550. Date of Electronic Publication: 2019 Apr 23.
DOI: 10.1007/s00464-019-06792-0
Abstrakt: 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.
Databáze: MEDLINE
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