Preoperative predictive factors of laparoscopic distal pancreatectomy difficulty. Issue 12 (December 2020)

• Record Type: Journal Article
• Authors: Partelli, Stefano; Ricci, Claudio; Rancoita, Paola M.V.; Montorsi, Roberto; Andreasi, Valentina; Ingaldi, Carlo; Arru, Giaime; Pecorelli, Nicolò; Crippa, Stefano; Alberici, Laura; Di Serio, Clelia; Casadei, Riccardo; Falconi, Massimo
• Is Part Of: HPB. Volume 22:Issue 12(2020)
• Page Start: 1766
• Page End: 1774
• Publication Date: 2020-12
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1016/j.hpb.2020.04.002
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: Laparoscopic distal pancreatectomy (LDP) is a challenging operation due to technical complexity and tumor-related factors. Aim of this study was to identify preoperative risk factors affecting LDP difficulty. Methods: Consecutive patients who underwent LDP between 2015 and 2018 at San Raffaele Hospital and Policlinico S.Orsola-Malpighi Hospital were enrolled retrospectively. Three variables were used to define surgical difficulty: conversion to open, duration of surgery >3rd quartile and intraoperative blood loss >3rd quartile. The presence of ≥1 of these 3 variables was considered as another measure of difficulty. Results: Overall, 191 patients were included. Conversion to open was required in 25 patients (13%). At multiple regression analysis, tumor proximity to major vessels was the only independent predictor of conversion from laparoscopic to open (p < 0.001). No variables independently predicted an excessive duration of surgery. Male gender (p = 0.033) and increasing parenchymal thickness at resection line (p = 0.018) were independent predictors of excessive blood loss. Increasing parenchymal thickness at resection line (p = 0.014) and tumor proximity to major vessels (p = 0.002) were significant risk factors for the presence of ≥1 outcome of surgical difficulty. Conclusion: Male gender, increasing parenchymal thickness at resection line and tumor proximity to major vessels represent preoperative risk factors of LDP difficulty.