title: Factors associated with and consequences of open conversion after laparoscopic distal pancreatectomy: initial experience at a single institution.
abstract: BACKGROUND
  Laparoscopic distal pancreatectomy (LDP) is increasingly adopted today. This study aims to determine factors associated with and consequences of open conversion after LDP.
  
  
  METHODS
  Retrospective review of the first 40 consecutive LDP performed for pancreatic tumors from 2006 to 2015 was performed. Individual surgeon volume was stratified by ≤5 versus >5 cases and institution experience was stratified by two time periods 2006-2010 and 2011-2015.
  
  
  RESULTS
  Two high-volume surgeons performed 19 cases with an average case volume of ≥2/year whereas 10 low-volume surgeons performed 21 cases with an average case volume of <1/year. Median age of patients was 57.6 (range, 21-78) years. LDP was performed for malignancy in four (10%) patients. The median tumor size was 25 (range, 8-75) mm. Eight patients (20%) underwent subtotal pancreatectomies and seven (17.5%) had concomitant surgeries. Eleven (27.5%) LDP were spleen-saving procedures. Ten (25%) procedures were converted to open. Twenty-nine (72.5%) patients experienced 90-day/in-hospital morbidity of which eight (20%) were major (>grade II). There were 24 (60%) pancreatic fistulas of which 10 (25%) were grade B. Univariate analyses demonstrated that splenectomy (10 (34.5%) versus 0, P = 0.025), individual surgeon volume (<5 cases) (8 (38.1%) versus 2 (10.15%), P = 0.044) and institution experience (5 (55.6%) versus 5 (16.1%), P = 0.016) were factors associated with open conversion after LDP. Open conversion was associated with an increased rate of intra-operative blood transfusion (P = 0.053).
  
  
  CONCLUSIONS
  Splenectomy, institution experience and individual surgeon volume were the factors associated with open conversion after LDP.
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.|Duke-NUS Graduate Medical School, Singapore.
authors.forename: Brian K P
authors.initials: BKP
authors.lastname: Goh
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
authors.forename: Chung Yip
authors.initials: CY
authors.lastname: Chan
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
authors.forename: Ser Yee
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Upper Gastrointestinal Tract and Bariatric Surgery, Singapore General Hospital, Singapore.
authors.forename: Weng Hoong
authors.initials: WH
authors.lastname: Chan
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
authors.forename: Peng Chung
authors.initials: PC
authors.lastname: Cheow
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.|Duke-NUS Graduate Medical School, Singapore.
authors.forename: Pierce K H
authors.initials: PKH
authors.lastname: Chow
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.|Duke-NUS Graduate Medical School, Singapore.
authors.forename: London L P J
authors.initials: LLPJ
authors.lastname: Ooi
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
authors.forename: Alexander Y F
authors.initials: AYF
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D001803:Blood Transfusion / Q000639:trends; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data / Q000639:trends*; D015981:Epidemiologic Factors; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010185:Pancreatic Fistula / Q000150:complications; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D000068616:Professionalism; D011446:Prospective Studies; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods; D013156:Splenectomy / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: conversion; laparoscopic distal pancreatectomy; laparoscopic pancreatectomy; outcome; robotic pancreatectomy