Factors associated with and impact of open conversion on the outcomes of minimally invasive left lateral sectionectomies: An international multicenter study
Hao Ping Wang 1 , Chee Chien Yong 1 , Andrew G R Wu 2 , Daniel Cherqui 3 , Roberto I Troisi 4 , Federica Cipriani 5 , Davit Aghayan 6 , Marco V Marino 7 , Andrea Belli 8 , Adrian K H Chiow 9 , Iswanto Sucandy 10 , Arpad Ivanecz 11 , Marco Vivarelli 12 , Fabrizio Di Benedetto 13 , Sung-Hoon Choi 14 , Jae Hoon Lee 15 , James O Park 16 , Mikel Gastaca 17 , Constantino Fondevila 18 , Mikhail Efanov 19 , Fernando Rotellar 20 , Gi-Hong Choi 21 , Ricardo Robles Campos 22 , Xiaoying Wang 23 , Robert P Sutcliffe 24 , Johann Pratschke 25 , Chung Ngai Tang 26 , Charing C Chong 27 , Mathieu D'Hondt 28 , Andrea Ruzzenente 29 , Paolo Herman 30 , T Peter Kingham 31 , Olivier Scatton 32 , Rong Liu 33 , Alessandro Ferrero 34 , Giovanni Battista Levi Sandri 35 , Olivier Soubrane 36 , Alejandro Mejia 37 , Santiago Lopez-Ben 38 , Jasper Sijberden 39 , Kazuteru Monden 40 , Go Wakabayashi 41 , Atsushi Sugioka 42 , Tan-To Cheung 43 , Tran Cong Duy Long 44 , Bjorn Edwin 6 , Ho-Seong Han 45 , David Fuks 36 , Luca Aldrighetti 5 , Mohamed Abu Hilal 46 , Brian K P Goh 47 , International Robotic and Laparoscopic Liver Resection Study Group Investigators
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.
CITA DE ARTÍCULO Surgery. 2022 Jun 7;S0039-6060(22)00221-5. doi: 10.1016/j.surg.2022.03.037