Factors associated with and impact of open conversion on the outcomes of minimally invasive left lateral sectionectomies: An international multicenter study.
Wang, Hao Ping Yong, Chee Chien Wu, Andrew G R Cherqui, Daniel Troisi, Roberto I Cipriani, Federica Aghayan, Davit Marino, Marco V Belli, Andrea Chiow, Adrian K H
Wang, Hao Ping
Yong, Chee Chien
Wu, Andrew G R
Cherqui, Daniel
Troisi, Roberto I
Cipriani, Federica
Aghayan, Davit
Marino, Marco V
Belli, Andrea
Chiow, Adrian K H
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2022-06-07
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Abstract
Background: Despite the rapid advances that minimally invasive liver resection has gained in recent decades, open conversion is still inevitable in some circumstances. In this study, we aimed to determine the risk factors for open conversion after minimally invasive left lateral sectionectomy, and its impact on perioperative outcomes.
Methods: This is a post hoc analysis of 2,445 of 2,678 patients who underwent minimally invasive left lateral sectionectomy at 45 international centers between 2004 and 2020. Factors related to open conversion were analyzed via univariate and multivariate analyses. One-to-one propensity score matching was used to analyze outcomes after open conversion versus non-converted cases.
Results: The open conversion rate was 69/2,445 (2.8%). On multivariate analyses, male gender (3.6% vs 1.8%, P = .011), presence of clinically significant portal hypertension (6.1% vs 2.6%, P = .009), and larger tumor size (50 mm vs 32 mm, P < .001) were identified as independent factors associated with open conversion. The most common reason for conversion was bleeding in 27/69 (39.1%) of cases. After propensity score matching (65 open conversion vs 65 completed via minimally invasive liver resection), the open conversion group was associated with increased operation time, blood transfusion rate, blood loss, and postoperative stay compared with cases completed via the minimally invasive approach.
Conclusion: Male sex, portal hypertension, and larger tumor size were predictive factors of open conversion after minimally invasive left lateral sectionectomy. Open conversion was associated with inferior perioperative outcomes compared with non-converted cases.
Citation
Wang HP, Yong CC, Wu AGR, Cherqui D, Troisi RI, Cipriani F, Aghayan D, Marino MV, Belli A, Chiow AKH, Sucandy I, Ivanecz A, Vivarelli M, Di Benedetto F, Choi SH, Lee JH, Park JO, Gastaca M, Fondevila C, Efanov M, Rotellar F, Choi GH, Campos RR, Wang X, Sutcliffe RP, Pratschke J, Tang CN, Chong CC, D'Hondt M, Ruzzenente A, Herman P, Kingham TP, Scatton O, Liu R, Ferrero A, Levi Sandri GB, Soubrane O, Mejia A, Lopez-Ben S, Sijberden J, Monden K, Wakabayashi G, Sugioka A, Cheung TT, Long TCD, Edwin B, Han HS, Fuks D, Aldrighetti L, Abu Hilal M, Goh BKP; International Robotic and Laparoscopic Liver Resection Study Group Investigators. Factors associated with and impact of open conversion on the outcomes of minimally invasive left lateral sectionectomies: An international multicenter study. Surgery. 2022 Aug;172(2):617-624. doi: 10.1016/j.surg.2022.03.037. Epub 2022 Jun 7
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