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. 2025 Feb 28.
doi: 10.1097/SLA.0000000000006685. Online ahead of print.

Conversion during Minimally Invasive Left Pancreatectomy: A Nationwide Study of Causes and Consequences

Charles De Ponthaud  1   2   3 , Alexandra Nassar  4 , Safi Dokmak  5 , Thibaud Bertrand  5 , Julien De Martino  5 , Clément Pastier  1 , Antoine Castel  6 , Raffaele De Rosa  6 , Mehdi Boubaddi  7 , Abdallah Iben-Khayat  8 , Fabio Giannone  9 , Elsa Jolly  10 , Jonathan Garnier  11 , Clément Louis-Gaubert  12 , Alessandro D Mazzotta  13 , Marie André  14 , Johan Gagnière  15 , Manon Viennet  16 , François-Régis Souche  17 , Reza Kianmanesh  18 , Renato Micelli Lupinacci  19 , Jean-Marc Regimbeau  20 , François Paye  21 , Pietro Addeo  22 , Alexis Laurent  23 , Morgan Vandermeulen  24 , Robert Caiazzo  25 , Mehdi El Amrani  26 , Christophe Tresallet  27 , Alexandre Doussot  28 , Martin Brunel  29 , Lionel Jouffret  30 , Amandine Pinto  31 , Alain Valverde  32 , Rodolfo Romero Vece  33 , Régis Fara  34 , Samir Mahfouf  35 , Benjamin Darnis  36 , Amine Chamakhi  37 , Jeremie Thereaux  38 , Jean Lubrano  39 , Edouard Girard  40 , Julie Veziant  41 , David Jérémie Birnbaum  42 , Jérôme Danion  43 , Helene Corté  44 , Johanna Zemour  45 , Tullio Piardi  46 , Anne de Carbonnières  47 , Emilia Ragot  48 , Alban Zarzavadjian Le Bian  49 , Patrice David  50 , Laurent Brunaud  51 , Emilie Lermite  52 , Laura Chreim  53 , Ana Lucia Charlaix  53 , Jean Gugenheim  54 , Lilian Schwarz  55 , Jean Marc Bigourdan  56 , Bertrand Le Roy  57 , Elias Karam  58 , Rami Rhaiem  18 , Jean-Michel Fabre  17 , Jean-Baptiste Lequeu  16 , Marie Noirault  15 , Ahmet Ayav  14 , Olivier Soubrane  13 , Nicolas Regenet  12 , Olivier Turrini  11 , Fabrice Muscari  10 , Patrick Pessaux  9 , Baudouin Thébault  8 , Christophe Laurent  7 , Laurent Sulpice  6 , Alain Sauvanet  5 , David Fuks  4 , Sébastien Gaujoux  1   3 ; AFC- study group
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Free article

Conversion during Minimally Invasive Left Pancreatectomy: A Nationwide Study of Causes and Consequences

Charles De Ponthaud et al. Ann Surg. .
Free article

Abstract

Objectives: To identify risk factors for conversion, develop a predictive Conversion Risk Score (CRS), and assess the association between conversion and severe postoperative complications.

Background: Conversion occurs in 15-30% of minimally invasive left pancreatectomies (MILP). Risk factors and potential negative impacts on postoperative outcomes are poorly described.

Methods: Retrospective, nationwide, multicenter study including all MILP (laparoscopy and robot) performed between 2010 and 2021. Risk factors for conversion were identified by multivariate mixed model, and a CRS was developed on a "training-set" and validated (calibration diagrams and ROC curves) on a "validation-set." The association between severe complications and conversion was assessed using a propensity score based on the main risk factors for severe complications: age, sex, BMI, ASA score, tumor malignancy, multi-organ resection, operative duration, blood loss, splenectomy.

Results: 2104 patients included from 55 centers. Conversion occurred in 15.6% of MILP. Its risk factors were male sex (OR=1.67;P=0.048), BMI≥25 kg/m2 (OR=2.15;P=0.004), history of laparotomy (OR=2.9;P<0.001), initial pancreatitis (OR=3.58;P=0.007), tumor size≥40 mm (OR=2.12;P=0.003), planned splenectomy (OR=2.63;P<0.001), unplanned splenectomy (OR=4.05;P=0.028), portal vein resection (OR=36.3;P=0.002), multi-organ resection (OR=12.97;P<0.001). A predictive CRS was created based only on preoperatively available variables (the first six), with scores ranging from 0 to 7, corresponding to a conversion risk of 2% to 100%. No association was observed with tumor malignancy, robotic approach, or pancreatectomy volume. Conversion was significantly associated with severe complications [OR=1.80(1.16-2.54)], independent of other risk factors for complications.

Conclusions: Conversion during MILP can be predicted by CRS, aiding surgeons in decision-making, given its significant association with severe complications.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES: No disclosures reported.