Accès ouvert déclaré2025article

Conversion during Minimally Invasive Left Pancreatectomy

Charles de Ponthaud, Alexandra Nassar, Safi Dokmak, Thibaud Bertrand, Julien de Martino, Clément Pastier, Raffaele De Rosa, Mehdi Boubaddi, Abdallah Iben-Khayat, Fabio Giannone, Jonathan Garnier, Clément Louis-Gaubert, Alessandro Mazzotta, Marie André, Johan Gagnière, Manon Viennet, Régis Souche, Réza Kianmanesh, Renato Micelli Lupinacci, Jean-Marc Regimbeau, François Paye, Pietro Addeo, Alexis Laurent, Morgan Vandermeulen, Robert Caïazzo, Mehdi El Amrani, Christophe Tresallet, Alexandre Doussot, Lionel Jouffret, Amandine Pinto, A. Valverde, Rodolfo Romero Vece, Régis Fara, Samir Mahfouf, Benjamin Darnis, Amine Chamakhi, Jérémie Thereaux, Jean Lubrano, Édouard Girard, Julie Véziant, David Jérémie Birnbaum, J. Danion, Hélène Corté, Johanna Zemour, Tullio Piardi, Anne de Carbonnières, Emilia Ragot, Alban Zarzavadjian Le Bian, Patrice David, Laurent Brunaud, Émilie Lermite, Laura Chreim, Ana Lucia Charlaix, Jean Gugenheim, Lilian Schwarz, Jean Marc Bigourdan, Bertrand Le Roy, Elias Karam, Rami Rhaiem, Jean‐Michel Fabre, Jean-Baptiste Lequeu, Marie Noirault, Ahmet Ayav, Olivier Soubrane, Nicolas Régenet, Olivıer Turrini, Fabrice Muscari, Patrick Pessaux, B. Thebault, Christophe Laurent, Laurent Sulpice, Alain Sauvanet, David Fuks, Sébastien Gaujoux

7Citations signalées
65Institutions associées
5Pays d’affiliation

Résumé fourni par la source

OBJECTIVES: To identify risk factors for conversion, develop a predictive Conversion Risk Score (CRS), and assess the association between conversion and severe postoperative complications. BACKGROUND: Conversion occurs in 15-30% of minimally invasive left pancreatectomies (MILP). Risk factors and potential negative impacts on postoperative outcomes are poorly described. METHODS: Retrospective, nationwide, multicenter study including all MILP (laparoscopy and robot) performed between 2010 and 2021. Risk factors for conversion were identified by multivariate mixed model, and a CRS was developed on a "training-set" and validated (calibration diagrams and ROC curves) on a "validation-set." The association between severe complications and conversion was assessed using a propensity score based on the main risk factors for severe complications: age, sex, BMI, ASA score, tumor malignancy, multi-organ resection, operative duration, blood loss, splenectomy. RESULTS: 2104 patients included from 55 centers. Conversion occurred in 15.6% of MILP. Its risk factors were male sex (OR=1.67;P=0.048), BMI≥25 kg/m2 (OR=2.15;P=0.004), history of laparotomy (OR=2.9;P<0.001), initial pancreatitis (OR=3.58;P=0.007), tumor size≥40 mm (OR=2.12;P=0.003), planned splenectomy (OR=2.63;P<0.001), unplanned splenectomy (OR=4.05;P=0.028), portal vein resection (OR=36.3;P=0.002), multi-organ resection (OR=12.97;P<0.001). A predictive CRS was created based only on preoperatively available variables (the first six), with scores ranging from 0 to 7, corresponding to a conversion risk of 2% to 100%. No association was observed with tumor malignancy, robotic approach, or pancreatectomy volume. Conversion was significantly associated with severe complications [OR=1.80(1.16-2.54)], independent of other risk factors for complications. CONCLUSIONS: Conversion during MILP can be predicted by CRS, aiding surgeons in decision-making, given its significant association with severe complications.

Institutions

InsermUniversité Paris CitéSorbonne UniversitéSorbonne Paris CitéAssistance Publique – Hôpitaux de ParisPitié-Salpêtrière HospitalHôpital CochinHôpital BeaujonCentre de Recherche sur l'InflammationHôpital PontchaillouCentre Hospitalier Universitaire de RennesCentre Hospitalier Universitaire de BordeauxCentre hospitalier universitaire d'OrléansHôpitaux Universitaires de StrasbourgUniversité Fédérale de Toulouse Midi-PyrénéesAix-Marseille UniversitéInstitut Paoli-CalmettesCentre Hospitalier Universitaire de NantesInstitute Mutualiste MontsourisCentre Hospitalier Régional et Universitaire de NancyCentre Hospitalier Universitaire de Clermont-FerrandMaison des Sciences sociales et des Humanités de DijonHôpital Saint EloiUniversité de Reims Champagne-ArdenneHôpital Ambroise-ParéCentre Hospitalier Universitaire Amiens-PicardieUniversité de StrasbourgUniversité Paris-Est CréteilUniversity of LiègeCentre Hospitalier Universitaire de LiègeUniversité de LilleCentre Hospitalier Universitaire de LilleHôpital Claude HuriezUniversité Sorbonne Paris NordCentre Hospitalier Universitaire de BesançonHôpital André MignotServices déconcentrés d'appui à la recherche Provence-Alpes-Côte d'AzurCentre Hospitalier de BigorreGroupe Hospitalier Diaconesses Croix Saint-SimonHôpital EuropéenHôpital Maison BlancheUniversité de Caen NormandieInstitut polytechnique de GrenobleCentre National de la Recherche ScientifiqueVetAgro SupTranslational Innovation in Medicine and ComplexityUniversité Grenoble AlpesCentre Hospitalier Universitaire de PoitiersHôpital Saint-LouisCentre Hospitalier Universitaire de La RéunionHôpital d'Instruction des Armées BéginLes Hôpitaux de ChartresHopitaux Civils de ColmarUniversité de LorraineUniversité d'AngersHôpital DupuytrenHôpital l'ArchetUniversité de Rouen NormandieCentre Hospitalier de PerpignanHôpital NordCentre Hospitalier Universitaire de Saint-ÉtienneUniversité de ToursSafe Work AustraliaClinique des CèdresState Committee on Science and Technology

Sujets associés

Pancreatic and Hepatic Oncology ResearchMinimally Invasive Surgical TechniquesSurgical Simulation and Training
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