Abstract

Introduction: Laparoscopic pancreatic resection (LPR) is more frequently performed but conversion and its impact on the outcome were not frequently studied. This single series studied risk factors and impact of conversion. Methods: This is a retrospective study from a prospectively maintained databas. Main contraindications for LPR were major vascular invasion and pancreatitis. Demographics, surgical, and postoperative outcome were compared between patients without or with conversion. Results: From 2008 to December 2019, 658 LPR were performed including 173 PD (26%), 327 DP (50%), 88 CP (13%), 67 Enucleation (10%) and 3 TP (1%). The applicability of the laparoscopic approach increased from 10% before 2010 to 40% in 2019. Conversion was observed in 21 patients (3%) and was urgent in 7 patients (1%). No difference in demographics data but conversion was more frequent in older patients (55 vs 62, p=0.054) and with malignant ampulloma (4% vs 14%,p=0.029). Conversion was observed after PD (5%), after DP (3%) and after CP and enucleation (1%). Less conversion was observed after 2016 (4%vs 2%,p=0.046) with only one in the last 2 years. Conversion was associated with increased mean operative duration (202 vs 303,p<0.001), more blood loss (192 vs 823,p<0.001) ) and transfusion (2% vs 62%,p<0.001). The post-operative outcome showed increased pulmonary complications (6% vs 24%,p=0.001) and hospital stay (16 vs 23,p=0.005). Conclusion: Conversion is associated with increased morbidity and hospital stay. The very low rate of conversion in this series can be explained by good understanding of the surgical difficulty and improvement of the surgical technique.

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