Response to Comment on "Outcomes of Elective and Emergency Conversion in Minimally Invasive Distal Pancreatectomy for Pancreatic Ductal Adenocarcinoma: An International Multicenter Propensity Score-matched Study''

被引:24
|
作者
Lof, Sanne [1 ]
Korrel, Maarten [1 ]
Besselink, Marc G. [1 ]
Abu Hilal, Mohammed [2 ]
机构
[1] Univ Amsterdam, Dept Surg, Canc Ctr Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
[2] Poliambulanza Fdn Hosp, Dept Surg, Brescia, Italy
关键词
Conversion to open surgery; Minimally invasive surgical procedures; Pancreatectomy; Pancreatic ductal adenocarcinoma; Postoperative complications; Survival;
D O I
10.1097/SLA.0000000000003717
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: The aim of this study was to investigate the impact of conversion during minimally invasive distal pancreatectomy (MIDP) for pancreatic ductal adenocarcinoma (PDAC) on outcome by a propensity-matched comparison with open distal pancreatectomy (ODP). Background: MIDP is associated with faster recovery as compared with ODP. The high conversion rate (15%-25%) in patients with PDAC, however, is worrisome and may negatively influence outcome. Methods: A post hoc analysis of a retrospective cohort including distal pancreatectomies for PDAC from 34 centers in 11 countries. Patients requiring conversion were matched, using propensity scores, to ODP procedures (1:2 ratio). Indications for conversion were classified as elective conversions (eg, vascular involvement) or emergency conversions (eg, bleeding). Results: Among 1212 distal pancreatectomies for PDAC, 345 patients underwent MIDP, with 68 (19.7%) conversions, mostly elective (n = 46, 67.6%). Vascular resection (other than splenic vessels) was required in 19.1% of the converted procedures. After matching (61 MIDP-converted vs 122 ODP), conversion did not affect R-status, recurrence of cancer, nor overall survival. However, emergency conversion was associated with increased overall morbidity (61.9% vs 31.1%, P = 0.007) and a trend to worse oncological outcome compared with ODP. Elective conversion was associated with comparable overall morbidity. Conclusions: Elective conversion in MIDP for PDAC was associated with comparable short-term and oncological outcomes in comparison with ODP. However, emergency conversions were associated with worse both short- and long-term outcomes, and should be prevented by careful patient selection, awareness of surgeons' learning curve, and consideration of early conversion when unexpected intraoperative findings are encountered. © 2019 Wolters Kluwer Health, Inc.
引用
收藏
页码:E760 / E761
页数:2
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