Outcomes of Elective and Emergency Conversion in Minimally Invasive Distal Pancreatectomy for Pancreatic Ductal Adenocarcinoma: An International Multicenter Propensity Score-matched Study.

Autor:	Lof S; Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom.; Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy., Korrel M; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands., van Hilst J; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands., Moekotte AL; Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom., Bassi C; Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy., Butturini G; Department of Surgery, Pederzoli Hospital, Peschiera, Italy., Boggi U; Department of Surgery, Universitá di Pisa, Pisa, Italy., Dokmak S; Department of Surgery, Hospital of Beaujon, Clichy, France., Edwin B; The Intervention Centre, Department of HPB Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway., Falconi M; Pancreatic Department of Surgery, San Raffaele Hospital, Università 'Vita e Salute', Cologno Monzese, Italy., Fuks D; Département de Chirurgie Digestive, Oncologique et Métabolique, Institut Mutualiste Montsouris, Paris, France., de Pastena M; Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy., Zerbi A; Department of Surgery, Humanitas University Hospital, Milan, Italy., Besselink MG; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands., Abu Hilal M; Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom.; Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2021 Dec 01; Vol. 274 (6), pp. e1001-e1007.
DOI:	10.1097/SLA.0000000000003717
Abstrakt:	Objective: The aim of this study was to investigate the impact of conversion during minimally invasive distal pancreatectomy (MIDP) for pancreatic ductal adenocarcinoma (PDAC) on outcome by a propensity-matched comparison with open distal pancreatectomy (ODP). Background: MIDP is associated with faster recovery as compared with ODP. The high conversion rate (15%-25%) in patients with PDAC, however, is worrisome and may negatively influence outcome. Methods: A post hoc analysis of a retrospective cohort including distal pancreatectomies for PDAC from 34 centers in 11 countries. Patients requiring conversion were matched, using propensity scores, to ODP procedures (1:2 ratio). Indications for conversion were classified as elective conversions (eg, vascular involvement) or emergency conversions (eg, bleeding). Results: Among 1212 distal pancreatectomies for PDAC, 345 patients underwent MIDP, with 68 (19.7%) conversions, mostly elective (n = 46, 67.6%). Vascular resection (other than splenic vessels) was required in 19.1% of the converted procedures. After matching (61 MIDP-converted vs 122 ODP), conversion did not affect R-status, recurrence of cancer, nor overall survival. However, emergency conversion was associated with increased overall morbidity (61.9% vs 31.1%, P= 0.007) and a trend to worse oncological outcome compared with ODP. Elective conversion was associated with comparable overall morbidity. Conclusions: Elective conversion in MIDP for PDAC was associated with comparable short-term and oncological outcomes in comparison with ODP. However, emergency conversions were associated with worse both short- and long-term outcomes, and should be prevented by careful patient selection, awareness of surgeons' learning curve, and consideration of early conversion when unexpected intraoperative findings are encountered. Competing Interests: The authors report no conflicts of interest. (Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu