Adverse Impact of Intraoperative Conversion on the Postoperative Course Following Laparoscopic Pancreaticoduodenectomy

Abstract

Purpose The aim of the current study was to evaluate the adverse clinical impact of intraoperative conversion during laparoscopic pancreaticoduodenectomy (LPD). Materials and Methods The medical records of patients who underwent pancreaticoduodenectomy (PD) were retrospectively reviewed. Perioperative clinical variables were compared between patients who underwent converted PD (cPD) and initially planned open PD (OPD) to investigate the clinical impact and predictive factors of intraoperative conversion during LPD. Results A total of 171 patients were included. Among them, 31 patients (19.3%) were found to have intraoperative conversion during LPD. Failure of progression due to severe adhesion (12 patients, 7%) and major vessel invasion (7 patients, 4%) were the two most frequent reasons for conversion. On multivariate analysis, age [Exp(β)=1.044, p =0.044] and pancreatic texture [Expa(β)=2.431, p =0.039) were found to be independent factors for predicting intraoperative conversion during LPD. In comparative analysis with the OPD group, the cPD group had a longer operation time (516.8 min vs. 449.9 min, p =0.001), higher rate of postoperative hemorrhage (12.1% vs. 0.85%, p =0.008), higher reoperation rate (9.1% vs. 0%, p =0.01), and higher cost (21886.4 USD vs. 17168.9 USD, p =0.018). Conclusion Intraoperative conversion during LPD can have an adverse clinical impact on the postoperative course following LPD. Appropriate patients selection and improvement of surgical techniques will be crucial for unnecessary intraoperative conversion and safe LPD.

Impact of Unplanned Intra‐Operative Conversions on Outcomes in Minimally Invasive Pancreatoduodenectomy

“…Six retrospective cohort studies (four from the United States [25–28], one from Korea [29] and one multi‐national European study [30]) including a total of 20,267 patients, published between 2017 and 2022 were suitable for inclusion (Table 1). While 4 studies [25–28] were registry‐based, Lof et al .…”

“…[30] included medium (10–19 MIPD per year) and high (> 0 MIPD per year) volume centres in their study, and Connie et al . [29] conducted a single‐centre study. The latter [29] included only LPD cases, whilst the other studies [25–28, 30] included both LPD and RPD.…”

“…[29] conducted a single‐centre study. The latter [29] included only LPD cases, whilst the other studies [25–28, 30] included both LPD and RPD. Four studies compared all 3 cohorts, namely, ( unplanned ) converted MIPD, successfully completed MIPD and upfront open PD [25, 27–29].…”

“…Male sex [26–30], advanced age [11, 26–29], ASA grade III‐IV [29, 30], smoking [27] and patients who reported recent weight loss [27] had a higher likelihood of unplanned conversion. Hard pancreatic texture was found to be associated with ( unplanned ) conversion in 2 studies [27, 29]. Another factor found to be more prevalent in patients undergoing conversions was the presence of wider pancreatic ducts [29].…”

An analysis of risk factors for clinically relevant pancreatic fistulas after laparoscopic pancreaticoduodenectomy

“…[6,7] Laparoscopic pancreaticoduodenectomy (LPD), one of the most challenging abdominal surgical procedures, has been gradually applied in the resection of periampullary and pancreatic head tumors. [8] In 1994, Gagner and Pomp performed the first laparoscopic pancreaticoduodenectomies and opened the way for the development of laparoscopic technology in this field. [9][10][11] However, the postoperative recovery of the patients was unsatisfactory.…”