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.

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dc.contributor.authorMontalti, Roberto
dc.contributor.authorGiglio, Mariano Cesare
dc.contributor.authorWu, Andrew G R
dc.contributor.authorCipriani, Federica
dc.contributor.authorD'Silva, Mizelle
dc.contributor.authorSuhool, Amal
dc.contributor.authorNghia, Phan Phuoc
dc.contributor.authorKato, Yutaro
dc.contributor.authorLim, Chetana
dc.contributor.authorHerman, Paulo
dc.contributor.authorCoelho, Fabricio Ferreira
dc.contributor.authorSchmelzle, Moritz
dc.contributor.authorPratschke, Johann
dc.contributor.authorAghayan, Davit L
dc.contributor.authorLiu, Qiu
dc.contributor.authorMarino, Marco V
dc.contributor.authorBelli, Andrea
dc.contributor.authorChiow, Adrian K H
dc.contributor.authorSucandy, Iswanto
dc.contributor.authorIvanecz, Arpad
dc.contributor.authorDi Benedetto, Fabrizio
dc.contributor.authorChoi, Sung Hoon
dc.contributor.authorLee, Jae Hoon
dc.contributor.authorPark, James O
dc.contributor.authorPrieto, Mikel
dc.contributor.authorGuzman, Yoelimar
dc.contributor.authorFondevila, Constantino
dc.contributor.authorEfanov, Mikhail
dc.contributor.authorRotellar, Fernando
dc.contributor.authorChoi, Gi-Hong
dc.contributor.authorRobles-Campos, Ricardo
dc.contributor.authorWang, Xiaoying
dc.contributor.authorSutcliffe, Robert P
dc.contributor.authorTang, Chung Ngai
dc.contributor.authorChong, Charing C
dc.contributor.authorD'Hondt, Mathieu
dc.contributor.authorDalla Valle, Bernardo
dc.contributor.authorRuzzenente, Andrea
dc.contributor.authorKingham, T Peter
dc.contributor.authorScatton, Olivier
dc.contributor.authorLiu, Rong
dc.contributor.authorMejia, Alejandro
dc.contributor.authorMishima, Kohei
dc.contributor.authorWakabayashi, Go
dc.contributor.authorLopez-Ben, Santiago
dc.contributor.authorPascual, Franco
dc.contributor.authorCherqui, Daniel
dc.contributor.authorForchino, Fabio
dc.contributor.authorFerrero, Alessandro
dc.contributor.authorEttorre, Giuseppe Maria
dc.contributor.authorLevi Sandri, Giovanni Battista
dc.contributor.authorSugioka, Atsushi
dc.contributor.authorEdwin, Bjørn
dc.contributor.authorCheung, Tan-To
dc.contributor.authorLong, Tran Cong Duy
dc.contributor.authorAbu Hilal, Mohammad
dc.contributor.authorAldrighetti, Luca
dc.contributor.authorFuks, David
dc.contributor.authorHan, Ho-Seong
dc.contributor.authorTroisi, Roberto I
dc.contributor.authorGoh, Brian K P
dc.contributor.departmentLiver Uniten_US
dc.contributor.roleMedical and Dentalen_US
dc.contributor.trustauthorSutcliffe, Robert P
dc.date.accessioned2023-07-05T13:50:50Z
dc.date.available2023-07-05T13:50:50Z
dc.date.issued2023-05-18
dc.description.abstractIntroduction: 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. Methods: 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. Results: 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. Conclusions: 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.en_US
dc.identifier.citationMontalti R, Giglio MC, Wu AGR, Cipriani F, D'Silva M, Suhool A, Nghia PP, Kato Y, Lim C, Herman P, Coelho FF, Schmelzle M, Pratschke J, Aghayan DL, Liu Q, Marino MV, Belli A, Chiow AKH, Sucandy I, Ivanecz A, Di Benedetto F, Choi SH, Lee JH, Park JO, Prieto M, Guzman Y, Fondevila C, Efanov M, Rotellar F, Choi GH, Robles-Campos R, Wang X, Sutcliffe RP, Tang CN, Chong CC, D'Hondt M, Dalla Valle B, Ruzzenente A, Kingham TP, Scatton O, Liu R, Mejia A, Mishima K, Wakabayashi G, Lopez-Ben S, Pascual F, Cherqui D, Forchino F, Ferrero A, Ettorre GM, Levi Sandri GB, Sugioka A, Edwin B, Cheung TT, Long TCD, Abu Hilal M, Aldrighetti L, Fuks D, Han HS, Troisi RI, Goh BKP; International Robotic and Laparoscopic Liver Resection Study Group Investigators. 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. Ann Surg Oncol. 2023 May 18. doi: 10.1245/s10434-023-13525-0. Epub ahead of print.en_US
dc.identifier.doi10.1245/s10434-023-13525-0
dc.identifier.eissn1534-4681
dc.identifier.pmid37202573
dc.identifier.urihttp://hdl.handle.net/20.500.14200/1175
dc.language.isoenen_US
dc.publisherSpringeren_US
dc.relation.urlhttps://link.springer.com/journal/10434en_US
dc.rights© 2023. Society of Surgical Oncology.
dc.source.countryUnited States
dc.source.journaltitleAnnals of Surgical Oncology
dc.subjectGastroenterologyen_US
dc.subjectSurgeryen_US
dc.titleRisk factors and outcomes of open conversion during minimally invasive major hepatectomies: an international multicenter study on 3880 procedures comparing the laparoscopic and robotic approaches.en_US
dc.typeArticle
dspace.entity.typePublication
oa.grant.openaccessnaen_US
rioxxterms.versionNAen_US
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