Department of Surgery, University Hospital, Verona, Italy.
Department of Surgery, Southampton University Hospital, Southampton, UK.
Langenbecks Arch Surg. 2021 May;406(3):597-605. doi: 10.1007/s00423-020-02043-2. Epub 2020 Dec 10.
The reported conversion rates for minimally invasive distal pancreatectomy (MIDP) range widely from 2 to 38%. The identification of risk factors for conversion may help surgeons during preoperative planning and patient counseling. Moreover, the impact of conversion on outcomes of MIDP is unknown.
A systematic review was conducted as part of the 2019 Miami International Evidence-Based Guidelines on Minimally Invasive Pancreas Resection (IG-MIPR). The PubMed, Cochrane, and Embase databases were searched for studies concerning conversion to open surgery in MIDP.
Of the 828 studies screened, eight met the eligibility criteria, resulting in a combined dataset including 2592 patients after MIDP. The overall conversion rate was 17.1% (range 13.0-32.7%) with heterogeneity between studies associated with the definition of conversion adopted. Only one study divided conversion into elective and emergency conversion. The main indications for conversion were vascular involvement (23.7%), concern for oncological radicality (21.9%), and bleeding (18.9%). The reported risk factors for conversion included a malignancy as an indication for surgery, the proximity of the tumor to vascular structures in preoperative imaging, higher BMI or visceral fat, and multi-organ resection or extended resection. Contrasting results were seen in terms of blood loss and length of stay in comparing converted MIDP and completed MIDP patients.
The identified risk factors for conversion from this study can be used for patient selection and counseling. Surgeon experience should be considered when contemplating MIDP for a complex patient. Future studies should divide conversion into elective and emergency conversion.
微创远端胰腺切除术（MIDP）的转换率报道范围很广，为 2%至 38%。识别转换的风险因素可能有助于外科医生在术前规划和患者咨询时做出决策。此外，转换对 MIDP 结果的影响尚不清楚。
作为 2019 年迈阿密国际微创胰腺切除术循证指南（IG-MIPR）的一部分，进行了系统评价。检索了 PubMed、Cochrane 和 Embase 数据库中关于 MIDP 中转开腹手术的研究。
在筛选的 828 项研究中，有 8 项符合纳入标准，对这 8 项研究的汇总数据包括 2592 例接受 MIDP 后的患者。总体转换率为 17.1%（范围 13.0%-32.7%），研究间存在异质性，原因是采用的转换定义不同。只有一项研究将转换分为选择性和紧急性转换。转换的主要指征包括血管受累（23.7%）、对肿瘤根治性的关注（21.9%）和出血（18.9%）。报告的转换风险因素包括作为手术指征的恶性肿瘤、术前影像学上肿瘤与血管结构的接近程度、较高的 BMI 或内脏脂肪、多器官切除或广泛切除。在比较转换后的 MIDP 和完成的 MIDP 患者时，出血和住院时间的结果存在差异。
本研究确定的转换风险因素可用于患者选择和咨询。在考虑对复杂患者进行 MIDP 时，应考虑外科医生的经验。未来的研究应将转换分为选择性和紧急性转换。
