Ismael Gomez, Villodre C, Hernández-Roca B, Rubio-García Jj, Juli Busquets, Luis Secanella, Nuria Peláez, Maialen Alkorta, Itziar De Ariño Hervas, Mᵃ Mar Achalandabaso, Enrique Toledo, Fernando Rotellar, Pablo Martí-Cruchaga, Miguel Ángel Gómez-Bravo, Gonzalo Suárez, Marina Garcés-Albir, Luis Sabater, Gabriel García, Francisco Javier Alcalá, Enrique Asensio, David Pacheco, Esteban Cugat, Francisco Espín, María Galófre, Belinda Sánchez, Julio Santoyo, Jorge Calvo, Carmelo Loinaz, Maribel García, Santiago Sánchez-Cabús, Belén Martín, Gerardo Blanco, Isabel Jaén-Torrejimeno, Carlos Domingo, Carmen Payá, Carmen González, Sandra Ruiz, Rafael López-Andújar, Cristina Ballester, Ana Belén Vico, Natalia Zambudio, Sergio Estévez, Manuel Nogueira-Sixto, José Ignacio Miota, Belén Conde, Miguel Ángel Suárez, Jorge Roldán de la Rúa, Angelica Blanco, Manuel González, Pilar Elena González, Betsabé Reyes, Santiago López Ben, Berta Tió, Javier Mínguez, Inmaculada Lasa, Alberto Miyar, Lorena Solar, Fernando Burdio, Benedetto Ielpo, Alberto Carabias, María Paloma, Alfredo Escartín, Fulthon Vela, Elia Marqués, Adelino Pérez, Gloria Palomares, Antonio Calvo, José Tomás Castell, María Jesús Castro, M Carmen Manzanares, Enrique Artigues, Juan Luis Blas, Luis Díez, Alicia Calero, José E Quiñones, Mario Rodríguez, Mario Serradilla-Martín, Cándido Alcázar, Ramia Jm
Conversion to open surgery during MILP is primarily driven by intraoperative bleeding-related events rather than by preoperative patient or tumor characteristics. Treatment at a high-volume center was associated with a lower conversion rate, although this trend did not reach significance after multivariable adjustment. Conversion was not associated with a significant increase in major morbidity or mortality in this cohort, supporting its use as a proactive safety measure rather than a surgical failure, although the limited number of conversion events warrants a cautious interpretation of this negative finding.
BACKGROUND: Minimally invasive left pancreatectomy (MILP) has become the preferred approach to treat lesions of the pancreatic body and tail. However, the procedure may require conversion to open surgery, with reported conversion rates varying widely in the literature. This study aims to evaluate the incidence, causes, and clinical outcomes associated with conversion to open surgery in a prospective multicenter series.
METHODS: The SPANDISPAN Project is a prospective, multicenter study conducted at 41 Spanish hospitals from February 2022 to January 2023. Patients were divided into conversion and nonconversion groups to identify predictors using univariate and multivariate logistic regression models.
RESULTS: Of 313 recorded left pancreatectomies, 217 (69.3%) were MILP procedures. The conversion rate was 10.6%. Reasons for conversion included hemorrhage (60.9%) and intraoperative technical difficulties (39.1%). Multivariable analysis identified intraoperative blood loss (OR 1.65 per 100-mL increment; p < 0.001) and intraoperative transfusion (OR 7.777; p = 0.012) as independent intraoperative correlates of conversion, reflecting the bleeding-related process leading to conversion rather than preoperative predictors available for case selection. Low center volume was associated with a higher conversion rate in univariable analysis (14.5% vs. 6%; p = 0.042) with a nonsignificant protective trend for high-volume centers after multivariable adjustment (OR 0.339; p = 0.075). Although patients who required conversion had longer operative times and hospital stays, there were no significant differences in major complications, postoperative pancreatic fistula, or mortality between the groups.
CONCLUSIONS: Conversion to open surgery during MILP is primarily driven by intraoperative bleeding-related events rather than by preoperative patient or tumor characteristics. Treatment at a high-volume center was associated with a lower conversion rate, although this trend did not reach significance after multivariable adjustment. Conversion was not associated with a significant increase in major morbidity or mortality in this cohort, supporting its use as a proactive safety measure rather than a surgical failure, although the limited number of conversion events warrants a cautious interpretation of this negative finding.