Risk Factors And Consequences Of Conversion In Minimally Invasive Distal Pancreatectomy

Background and objectiveMinimally invasive distal pancreatectomy(MIDP)had been widely used in clinical in recent years,and more and more literatures reported that it is a safe and feasible procedure.It has the advantages of small incisions,small trauma,and fast recovery,but the anatomy of the pancreas is complicated,and some cases are converted to open abdomen due to abdominal adhesions,tumor invasion,and difficult exposure.At present,there are limited researches on the transition of MIDP to open surgery.This study will explore the risk factors for conversion during MIDP and the influence of conversion on postoperative outcomes.MethodsAll data of patients who underwent distal pancreatectomy was collected from 2013 to 2018 in Sir Run Run Shaw Hospital.The patients were divided into the group of MIDP,the group of conversion and the group of open distal pancreatectomy group(ODP).Analyze the reasons of the conversion and the short-term outcomes of the three groups,including operative time,intra-operative blood loss,transfusion rate,postoperative complications,pancreatic fistula,postoperative hospitalization days,ICU occupancy rate,30-day mortality,90-day mortality and 30 day readmission.Single factor analysis was performed on related indicators,and statistically significant factors were selected.Multivariate logistic regression was used to obtained independent risk factors for conversion of MIDP.Results283 cases were included in this study: 225(79.5%)had MIDP,30(10.6%)had conversion,and 28(9.9%)had ODP.The reasons for conversion include adhesion(N=10,33.3%),anatomy of vessels(N=6,20.0%),extent of tumor invasive(N=5,16.7%),venous invasion(N=5,16.7%)and bleeding(N=4,13.3%).Compared with MIDP,those who required conversion were associated with longer operations(P=0.003),higher blood loss(P<0.001)and more severe of the complications(P< 0.001).However,no significant differences were found between the conversion group and ODP.The risk factors for conversion of MIDP included large lesion size(HR:5.632,95%CI:1.036-1.450,P=0.018)and pancreatic cancer(HR:6.957,95%CI: 1.359-8.022,P=0.008).ConclusionsConversion lead to worsening outcomes when compared with MIDP.Conversion did not lead to worsening outcomes when compared with ODP.Large lesion size and pancreatic cancer were reported to be independent risk factors for conversion during MIDP.