Nationwide analysis of unplanned conversion during minimally invasive distal pancreatectomy for pancreatic adenocarcinoma.

Autor:	Stiles ZE; Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA. Electronic address: Zachary.Stiles@roswellpark.org., Tolley EA; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA., Dickson PV; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA., Deneve JL; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA., Kocak M; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA., Behrman SW; Department of Surgery, Baptist Memorial Medical Education, Memphis, TN, USA.
Jazyk:	angličtina
Zdroj:	HPB : the official journal of the International Hepato Pancreato Biliary Association [HPB (Oxford)] 2023 Dec; Vol. 25 (12), pp. 1566-1572. Date of Electronic Publication: 2023 Aug 22.
DOI:	10.1016/j.hpb.2023.08.009
Abstrakt:	Background: Utilization of minimally-invasive distal pancreatectomy (MIDP) for pancreatic adenocarcinoma has increased. While unplanned conversion to an open procedure during MIDP is associated with inferior short-term outcomes, the long-term consequences of conversion have not been adequately examined. Methods: Patients with pancreatic adenocarcinoma undergoing MIDP were selected from the National Cancer Database (2010-2015) and subdivided based on the occurrence of unplanned conversion. Post-operative outcomes and overall survival (OS) were examined. Conversion was additionally compared to a matched group of planned open resections. Results: Among 592 patients undergoing attempted MIDP, unplanned conversion occurred in 23.1%. Despite increased 90-day mortality among patients experiencing conversion, there was no difference in median OS between groups (25.0 vs 27.8 months, p = 0.095). For patients undergoing conversion, post-operative outcomes and long-term survival were similar when compared to a propensity-matched group of patients undergoing planned open resection. On multivariable analysis, treatment at an academic facility (OR 0.63) and a robotic approach (OR 0.50) were both significantly associated with completed MIDP. Conclusion: Despite inferior post-operative outcomes compared to successful MIDP, unplanned conversion did not result in significantly reduced long term survival. MIDP can be attempted selectively but treatment at experienced centers via a robotic approach should be considered. (Copyright © 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu