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Factors associated with and consequences of open conversion after laparoscopic distal pancreatectomy: initial experience at a single institution
Author(s) -
Goh Brian K. P.,
Chan Chung Yip,
Lee Ser Yee,
Chan Weng Hoong,
Cheow Peng Chung,
Chow Pierce K. H.,
Ooi London L. P. J.,
Chung Alexander Y. F.
Publication year - 2017
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13661
Subject(s) - medicine , splenectomy , total pancreatectomy , surgery , distal pancreatectomy , malignancy , concomitant , pancreatectomy , univariate analysis , retrospective cohort study , laparoscopy , general surgery , multivariate analysis , spleen , resection
Background Laparoscopic distal pancreatectomy ( LDP ) is increasingly adopted today. This study aims to determine factors associated with and consequences of open conversion after LDP . Methods Retrospective review of the first 40 consecutive LDP performed for pancreatic tumors from 2006 to 2015 was performed. Individual surgeon volume was stratified by ≤5 versus >5 cases and institution experience was stratified by two time periods 2006–2010 and 2011–2015. Results Two high‐volume surgeons performed 19 cases with an average case volume of ≥2/year whereas 10 low‐volume surgeons performed 21 cases with an average case volume of <1/year. Median age of patients was 57.6 (range, 21–78) years. LDP was performed for malignancy in four (10%) patients. The median tumor size was 25 (range, 8–75) mm. Eight patients (20%) underwent subtotal pancreatectomies and seven (17.5%) had concomitant surgeries. Eleven (27.5%) LDP were spleen‐saving procedures. Ten (25%) procedures were converted to open. Twenty‐nine (72.5%) patients experienced 90‐day/in‐hospital morbidity of which eight (20%) were major (>grade II ). There were 24 (60%) pancreatic fistulas of which 10 (25%) were grade B. Univariate analyses demonstrated that splenectomy (10 (34.5%) versus 0, P = 0.025), individual surgeon volume (<5 cases) (8 (38.1%) versus 2 (10.15%), P = 0.044) and institution experience (5 (55.6%) versus 5 (16.1%), P = 0.016) were factors associated with open conversion after LDP . Open conversion was associated with an increased rate of intra‐operative blood transfusion ( P = 0.053). Conclusions Splenectomy, institution experience and individual surgeon volume were the factors associated with open conversion after LDP .