Publicaciones científicas
Factors Associated with and Impact of Open Conversion in Laparoscopic and Robotic Minor Liver Resections: An International Multicenter Study of 10,541 Patients
Mansour Saleh # 1 , Franco Pascual # 1 , Mohammed Ghallab 1 , Andrew G R Wu 2 , Ken-Min Chin 2 , Francesca Ratti 3 , Mariano Cesare Giglio 4 , Marco Garatti 5 , Phan Phuoc Nghia 6 , Yutaro Kato 7 , Chetana Lim 8 , Paulo Herman 9 , Fabricio Ferreira Coelho 9 , Moritz Schmelzle 10 , Johann Pratschke 10 , Davit L Aghayan 11 , Qiu Liu 12 , Marco V Marino 13 14 , Andrea Belli 15 , Adrian K H Chiow 16 , Iswanto Sucandy 17 , Arpad Ivanecz 18 , Fabrizio Di Benedetto 19 , Sung Hoon Choi 20 , Jae Hoon Lee 21 , James O Park 22 , Mikel Prieto 23 , Yoelimar Guzman 24 , Constantino Fondevila 24 25 , Mikhail Efanov 26 , Fernando Rotellar 27 28 , Gi-Hong Choi 29 , Ricardo Robles-Campos 30 , Prashant Kadam 31 , Robert P Sutcliffe 31 , Roberto I Troisi 4 , Chung Ngai Tang 32 , Charing C Chong 33 , Mathieu D'Hondt 34 , Bernardo Dalla Valle 35 , Andrea Ruzzenente 35 , T Peter Kingham 36 , Olivier Scatton 8 , Rong Liu 12 , Alejandro Mejia 37 , Kohei Mishima 38 , Go Wakabayashi 38 , Santiago Lopez-Ben 39 , Xiaoying Wang 40 , Alessandro Ferrero 41 , Giuseppe Maria Ettorre 42 , Marco Vivarelli 43 , Vincenzo Mazzaferro 44 , Felice Giuliante 45 , Chee Chien Yong 46 , Mengqiu Yin 47 , Kazuteru Monden 48 , David Geller 49 , Kuo-Hsin Chen 50 , Atsushi Sugioka 7 , Bjørn Edwin 11 , Tan-To Cheung 51 , Tran Cong Duy Long 6 , Mohammad Abu Hilal 5 52 , Luca Aldrighetti 3 , Olivier Soubrane 53 , David Fuks 53 , Ho-Seong Han 54 , Daniel Cherqui 1 , Brian K P Goh 55 56 ; International Robotic and Laparoscopic Liver Resection Study Group Investigators
Introduction: Despite the increasing widespread adoption and experience in minimally invasive liver resections (MILR), open conversion occurs not uncommonly even with minor resections and as been reported to be associated with inferior outcomes. We aimed to identify risk factors for and outcomes of open conversion in patients undergoing minor hepatectomies. We also studied the impact of approach (laparoscopic or robotic) on outcomes.
Methods: This is a post-hoc analysis of 20,019 patients who underwent RLR and LLR across 50 international centers between 2004-2020. Risk factors for and perioperative outcomes of open conversion were analysed. Multivariate and propensity score-matched analysis were performed to control for confounding factors.
Results: Finally, 10,541 patients undergoing either laparoscopic (LLR; 89.1%) or robotic (RLR; 10.9%) minor liver resections (wedge resections, segmentectomies) were included. Multivariate analysis identified LLR, earlier period of MILR, malignant pathology, cirrhosis, portal hypertension, previous abdominal surgery, larger tumor size, and posterosuperior location as significant independent predictors of open conversion. The most common reason for conversion was technical issues (44.7%), followed by bleeding (27.2%), and oncological reasons (22.3%). After propensity score matching (PSM) of baseline characteristics, patients requiring open conversion had poorer outcomes compared with successful MILR cases as evidenced by longer operative times, more blood loss, higher requirement for perioperative transfusion, longer duration of hospitalization and higher morbidity, reoperation, and 90-day mortality rates.
Conclusions: Multiple risk factors were associated with conversion of MILR even for minor hepatectomies, and open conversion was associated with significantly poorer perioperative outcomes.
CITA DEL ARTÍCULO Ann Surg Oncol. 2024 Jun 15. doi: 10.1245/s10434-024-15498-0
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