Conversion to open surgery in obese patients undergoing minimally invasive distal pancreatectomy: results from a multicenter analysis.

Autor:	Ausania F; Department of HBP Surgery and Transplantation, General and Digestive Surgery, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain., Gonzalez-Abós C; Department of HBP Surgery and Transplantation, General and Digestive Surgery, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain. Electronic address: carol.gonzaleza@gmail.com., Landi F; Department of HBP Surgery and Transplantation, General and Digestive Surgery, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain., Martinie JB; Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA., Vrochides D; Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA., Walsh M; HPB Surgery Department, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA., Hossain SM; HPB Surgery Department, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA., White S; Freeman Hospital, NHS, Newcastle-Upon-Tyne, UK., Prabakaran V; Freeman Hospital, NHS, Newcastle-Upon-Tyne, UK., Melstrom LG; Division of Surgical Oncology, Gastrointestinal Disease Team, City of Hope Medical Center, Duarte, CA, USA., Fong Y; Division of Surgical Oncology, Gastrointestinal Disease Team, City of Hope Medical Center, Duarte, CA, USA., Butturini G; Department of HBP Surgery, P. Pederzoli Hospital, Peschiera del Garda, Italy., Bignotto L; Department of HBP Surgery, P. Pederzoli Hospital, Peschiera del Garda, Italy., Valle V; Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA., Bing Y; Department of General Surgery, Beijing Third Hospital, Beijing, China., Xiu D; Department of General Surgery, Beijing Third Hospital, Beijing, China., Di Franco G; Division of Translational and New Technologies in Medicine and Surgery, General Surgery Department, University of Pisa, Pisa, Italy., Sanchez-Bueno F; Department of HBP Surgery, Virgen de la Arrixaca Hospital, Murcia, Spain., de'Angelis N; Department of Digestive, HBP Surgery and Liver Transplantation, Henri Mondor Hospital, APHP, Creteil, France., Laurent A; Department of Digestive, HBP Surgery and Liver Transplantation, Henri Mondor Hospital, APHP, Creteil, France., Giuliani G; Division of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy., Pernazza G; General and Robotic Surgery Department, San Giovanni Hospital, Rome, Italy., Esposito A; HBP Surgery Department, Policlinico G.B. Rossi Hospital, Verona, Italy., Salvia R; HBP Surgery Department, Policlinico G.B. Rossi Hospital, Verona, Italy., Bazzocchi F; Department of HBP Surgery, IRCCS Casa Sollievo della Soferenza Hospital, Foggia, Italy., Esposito L; Department of HBP Surgery, IRCCS Casa Sollievo della Soferenza Hospital, Foggia, Italy., Pietrabissa A; Department of HBP Surgery, Policlinico S. Matteo Hospital, Pavia, Italy., Pugliese L; Department of HBP Surgery, Policlinico S. Matteo Hospital, Pavia, Italy., Memeo R; Department of Surgery, Acquaviva delle Fonti Hospital, Bari, Italy., Uyama I; Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan., Uchida Y; Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan., Ríos J; Department of Clinical Pharmacology, Hospital Clinic and Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain., Coratti A; Division of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy., Morelli L; Division of Translational and New Technologies in Medicine and Surgery, General Surgery Department, University of Pisa, Pisa, Italy., Giulianotti PC; Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.
Jazyk:	angličtina
Zdroj:	HPB : the official journal of the International Hepato Pancreato Biliary Association [HPB (Oxford)] 2024 Sep; Vol. 26 (9), pp. 1172-1179. Date of Electronic Publication: 2024 May 29.
DOI:	10.1016/j.hpb.2024.05.016
Abstrakt:	Background: Although minimally invasive distal pancreatectomy (MIDP) is considered a standard approach it still presents a non-negligible rate of conversion to open that is mainly related to some difficulty factors, as obesity. The aim of this study is to analyze the preoperative factors associated with conversion in obese patients with MIDP. Methods: In this multicenter study, all obese patients who underwent MIDP at 18 international expert centers were included. The preoperative factors associated with conversion to open surgery were analyzed. Results: Out of 436 patients, 91 (20.9%) underwent conversion to open, presenting higher blood loss, longer operative time and similar rate of major complications. Twenty (22%) patients received emergent conversion. At univariate analysis, the type of approach, radiological invasion of adjacent organs, preoperative enlarged lymphnodes and ASA ≥ III were significantly associated with conversion to open. At multivariate analysis, robotic approach showed a significantly lower conversion rate (14.6 % vs 27.3%, OR = 2.380, p = 0.001). ASA ≥ III (OR = 2.391, p = 0.002) and preoperative enlarged lymphnodes (OR = 3.836, p = 0.003) were also independently associated with conversion. Conclusion: Conversion rate is significantly lower in patients undergoing robotic approach. Radiological enlarged lymphnodes and ASA ≥ III are also associated with conversion to open. Conversion is associated with poorer perioperative outcomes, especially in case of intraoperative hemorrhage. (Copyright © 2024. Published by Elsevier Ltd.)
Databáze:	MEDLINE
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