Risk Factors and Outcomes of Open Conversion During Minimally Invasive Major Hepatectomies: An International Multicenter Study on 3880 Procedures Comparing the Laparoscopic and Robotic Approaches.
Difficulty score
Laparoscopic
Liver surgery
Major hepatectomy
Minimally invasive hepatectomy
Open conversion
Robotic
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Aug 2023
Aug 2023
Historique:
received:
22
12
2022
accepted:
27
02
2023
medline:
7
7
2023
pubmed:
19
5
2023
entrez:
18
5
2023
Statut:
ppublish
Résumé
Despite the advances in minimally invasive (MI) liver surgery, most major hepatectomies (MHs) continue to be performed by open surgery. This study aimed to evaluate the risk factors and outcomes of open conversion during MI MH, including the impact of the type of approach (laparoscopic vs. robotic) on the occurrence and outcomes of conversions. Data on 3880 MI conventional and technical (right anterior and posterior sectionectomies) MHs were retrospectively collected. Risk factors and perioperative outcomes of open conversion were analyzed. Multivariate analysis, propensity score matching, and inverse probability treatment weighting analysis were performed to control for confounding factors. Overall, 3211 laparoscopic MHs (LMHs) and 669 robotic MHs (RMHs) were included, of which 399 (10.28%) had an open conversion. Multivariate analyses demonstrated that male sex, laparoscopic approach, cirrhosis, previous abdominal surgery, concomitant other surgery, American Society of Anesthesiologists (ASA) score 3/4, larger tumor size, conventional MH, and Institut Mutualiste Montsouris classification III procedures were associated with an increased risk of conversion. After matching, patients requiring open conversion had poorer outcomes compared with non-converted cases, as evidenced by the increased operation time, blood transfusion rate, blood loss, hospital stay, postoperative morbidity/major morbidity and 30/90-day mortality. Although RMH showed a decreased risk of conversion compared with LMH, converted RMH showed increased blood loss, blood transfusion rate, postoperative major morbidity and 30/90-day mortality compared with converted LMH. Multiple risk factors are associated with conversion. Converted cases, especially those due to intraoperative bleeding, have unfavorable outcomes. Robotic assistance seemed to increase the feasibility of the MI approach, but converted robotic procedures showed inferior outcomes compared with converted laparoscopic procedures.
Identifiants
pubmed: 37202573
doi: 10.1245/s10434-023-13525-0
pii: 10.1245/s10434-023-13525-0
doi:
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
4783-4796Subventions
Organisme : US National Cancer Institute MSKCC Core Grant
ID : P30 CA008747
Investigateurs
Nicholas L Syn
(NL)
Mikel Gastaca
(M)
Juul Meurs
(J)
Celine De Meyere
(C)
Eric C H Lai
(ECH)
Felix Krenzien
(F)
Prashant Kadam
(P)
Kit-Fai Lee
(KF)
Diana Salimgereeva
(D)
Ruslan Alikhanov
(R)
Lip-Seng Lee
(LS)
Jae Young Jang
(JY)
Kevin P Labadie
(KP)
Masayuki Kojima
(M)
Asmund Avdem Fretland
(AA)
Jacob Ghotbi
(J)
Jaime Arthur Pirola Kruger
(JAP)
Victor Lopez-Lopez
(V)
Paolo Magistri
(P)
Marco Colasanti
(M)
Margarida Casellas I Robert
(M)
Mansour Saleh
(M)
Edoardo Poletto
(E)
Informations de copyright
© 2023. Society of Surgical Oncology.
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