Abstract
Introduction: Minimally-invasive techniques are growing for liver resections. Laparoscopic and robotic liver resections may differ in unplanned conversions. We sought to identify risk factors for conversion and if conversion was associated with increased morbidity and mortality. Methods: This is an ACS-NSQIP multi-institutional retrospective study from 2014-2017. Patients were grouped into open, robotic and laparoscopic hepatectomy. Univariate and multivariate analysis (MVA) of factors associated with conversion and outcomes were investigated. Results: Of 14,055 patients who underwent hepatectomy, 10,279(73.1%) were open, 3,452(24.6%) were laparoscopic and 324(2.3%) were robotic. The rate of unplanned conversions was significantly lower in robotic vs laparoscopic (5.6% vs 15.4%; p< 0.001). Robotic hepatectomy was associated with decreased conversion for minor (5.5% vs 13.7%; p< 0.001), major (5.9% vs 23.8%; p=0.003) and right (3.2% vs 24.4%; p=0.007) hepatectomy compared to laparoscopic. Operative factors associated with conversion on MVA included concurrent intraoperative ablation (OR=1.49 [95% CI 1.13-1.96]; p=0.005), Pringle (OR=2.15 [95% CI 1.70-2.73]; p< 0.001), and laparoscopy (OR=3.00 [95% CI 1.85-4.86]; p< 0.001). Patients who underwent minimally-invasive hepatectomy with conversion were associated with increased bile leak (13% vs 4.5%; p< 0.001), 30-day readmission (11.7% vs 5.9%; p< 0.001), 30-day mortality (1.6% vs 0.5%; p=0.008), length of stay (5 days vs 3 days; p< 0.001), and increased surgical (29.7% vs 9.7%; p< 0.001), wound (9.1% vs 3.6%; p< 0.001) and medical (17% vs 6.6%; p< 0.001) complications (Table 1). Conclusion: Minimally-invasive hepatectomies with conversion are associated with increased complications. More conversions are associated with the laparoscopic approach compared to robotic.
Published Version
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