title: Factors associated with and outcomes of open conversion after laparoscopic minor hepatectomy: initial experience at a single institution.
abstract: BACKGROUND
  Laparoscopic liver resection has been increasingly adopted worldwide as a result of the rapid advancement in surgical techniques and equipment. This study aims to determine the factors associated with and outcomes of open conversion after laparoscopic minor hepatectomy (LMH) based on a single center multi-surgeon experience.
  
  
  METHODS
  This is a retrospective review of the first 147 consecutive LMH performed between 2006 and April 2014 at a single institution. Data on patient demographics, pathology results, perioperative outcomes, and operative results were collected. Factors associated with open conversion were analyzed via univariate analysis and a P value <.05 was considered statistically significant.
  
  
  RESULTS
  LMH was performed for malignancy in 114 (77.6%) patients of which hepatocellular carcinoma (n = 82) and colorectal metastases (n = 16) were the most common pathologies. Forty-one (27.9%) patients had cirrhotic livers and 18 (15.7%) had fibrotic livers. Fifty patients (44%) had concomitant surgery in addition to LMH. Twenty (13.6%) procedures required open conversion and the most common reason was for bleeding (n = 12). Twenty-five patients (17%) experienced postoperative complications. Univariate analyses demonstrated that only individual surgeon volume (n ≤ 10 cases) [15 (24.2%) vs 5 (5.9%), P = .001] and institution volume (n ≤ 25 cases) [8 (32%) vs 12 (9.8%), P = .003] were factors associated with open conversion. Open conversion was significantly associated with increased intra-operative blood loss, increased intra-operative blood transfusion, increased postoperative morbidity, and longer postoperative stay.
  
  
  CONCLUSIONS
  Individual surgeon and institution volumes were important factors associated with open conversion after LMH. Open conversion after LMH resulted in poorer outcomes compared to procedures that were successfully completed laparoscopically.
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore, bsgkp@hotmail.com.
authors.forename: Brian K P
authors.initials: BK
authors.lastname: Goh
authors.forename: Chung-Yip
authors.initials: CY
authors.lastname: Chan
authors.forename: Jen-San
authors.initials: JS
authors.lastname: Wong
authors.forename: Ser-Yee
authors.initials: SY
authors.lastname: Lee
authors.forename: Victor T W
authors.initials: VT
authors.lastname: Lee
authors.forename: Peng-Chung
authors.initials: PC
authors.lastname: Cheow
authors.forename: Pierce K H
authors.initials: PK
authors.lastname: Chow
authors.forename: London L P J
authors.initials: LL
authors.lastname: Ooi
authors.forename: Alexander Y F
authors.initials: AY
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D061887:Conversion to Open Surgery; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies