Assessing the impact of conversion on outcomes of minimally invasive distal pancreatectomy and pancreatoduodenectomy
| Autor: | Henry A. Pitt, Amer H. Zureikat, Melissa E. Hogg, Joal D. Beane, Scott C. Dolejs, Herbert J. Zeh |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Blood transfusion Percutaneous Time Factors Databases Factual medicine.medical_treatment 030230 surgery Pancreaticoduodenectomy 03 medical and health sciences Pancreatic Fistula 0302 clinical medicine Pancreatectomy Risk Factors medicine Humans Minimally Invasive Surgical Procedures Surgical Wound Infection Blood Transfusion Aged Retrospective Studies Hepatology business.industry General surgery Gastroenterology Retrospective cohort study Middle Aged medicine.disease Conversion to Open Surgery United States Surgery Treatment Outcome Pancreatic fistula 030220 oncology & carcinogenesis Propensity score matching Female business Distal pancreatectomy |
| Zdroj: | HPB : the official journal of the International Hepato Pancreato Biliary Association. 20(4) |
| ISSN: | 1477-2574 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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