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Article: 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

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
Authors
KeywordsDifficulty score
Laparoscopic
Liver surgery
Major hepatectomy
Minimally invasive hepatectomy
Open conversion
Robotic
Issue Date1-Aug-2023
PublisherSpringer
Citation
Annals of Surgical Oncology, 2023, v. 30, n. 8, p. 4783-4796 How to Cite?
Abstract

Introduction

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.


Persistent Identifierhttp://hdl.handle.net/10722/340661
ISSN
2023 Impact Factor: 3.4
2023 SCImago Journal Rankings: 1.037
ISI Accession Number ID

 

DC FieldValueLanguage
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.authorSyn, Nicholas L-
dc.contributor.authorGastaca, Mikel-
dc.contributor.authorMeurs, Juul-
dc.contributor.authorde Meyere, Celine-
dc.contributor.authorLai, Eric C H-
dc.contributor.authorKrenzien, Felix-
dc.contributor.authorKadam, Prashant-
dc.contributor.authorLee, Kit-Fai-
dc.contributor.authorSalimgereeva, Diana-
dc.contributor.authorAlikhanov, Ruslan-
dc.contributor.authorLee, Lip-Seng-
dc.contributor.authorJang, Jae Young-
dc.contributor.authorLabadie, Kevin P-
dc.contributor.authorKojima, Masayuki-
dc.contributor.authorFretland, Asmund Avdem-
dc.contributor.authorGhotbi, Jacob-
dc.contributor.authorKruger, Jaime Arthur Pirola-
dc.contributor.authorLopez-Lopez, Victor-
dc.contributor.authorMagistri, Paolo-
dc.contributor.authorColasanti, Marco-
dc.contributor.authorCasellas, I Robert Margarida-
dc.contributor.authorSaleh, Mansour-
dc.contributor.authorPoletto, Edoardo-
dc.date.accessioned2024-03-11T10:46:14Z-
dc.date.available2024-03-11T10:46:14Z-
dc.date.issued2023-08-01-
dc.identifier.citationAnnals of Surgical Oncology, 2023, v. 30, n. 8, p. 4783-4796-
dc.identifier.issn1068-9265-
dc.identifier.urihttp://hdl.handle.net/10722/340661-
dc.description.abstract<h3>Introduction</h3><p>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.</p><h3>Methods</h3><p>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.</p><h3>Results</h3><p>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.</p><h3>Conclusions</h3><p>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.</p>-
dc.languageeng-
dc.publisherSpringer-
dc.relation.ispartofAnnals of Surgical Oncology-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectDifficulty score-
dc.subjectLaparoscopic-
dc.subjectLiver surgery-
dc.subjectMajor hepatectomy-
dc.subjectMinimally invasive hepatectomy-
dc.subjectOpen conversion-
dc.subjectRobotic-
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-
dc.typeArticle-
dc.identifier.doi10.1245/s10434-023-13525-0-
dc.identifier.scopuseid_2-s2.0-85159823483-
dc.identifier.volume30-
dc.identifier.issue8-
dc.identifier.spage4783-
dc.identifier.epage4796-
dc.identifier.eissn1534-4681-
dc.identifier.isiWOS:000992101000003-
dc.identifier.issnl1068-9265-

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