Vol.:(0123456789) 1 3 Surgical Endoscopy https://doi.org/10.1007/s00464-018-6113-4 Laparoscopic distal pancreatectomy: which factors are related to open conversion? Lessons learned from 68 consecutive procedures in a high-volume pancreatic center Riccardo Casadei 1,2  · Claudio Ricci 1  · Carlo Alberto Pacilio 1  · Carlo Ingaldi 1  · Giovanni Tafurelli 1  · Francesco Minni 1 Received: 23 October 2017 / Accepted: 7 February 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Background Laparoscopic distal pancreatectomy represents a difcult surgical procedure with an high conversion rate to open procedure. The factors related to its difculty and conversion to open distal pancreatectomy were rarely reported. The aim of the present study was to identify which factors are related to conversion from laparoscopic to open distal pancreatectomy. Methods A retrospective study of a prospective database of 68 patients who underwent laparoscopic distal pancreatectomy was conducted at a high-volume center by pancreatic surgeons experienced with laparoscopic surgery. Pre-intra and post- operative data were collected. Patients who completed a laparoscopic distal pancreatectomy were compared with those who needed a conversion to the open approach as regard demographic, clinical, radiological, and surgical data. Univariate and multivariate analyses were carried out. Results Univariate analysis suggested that the site of the lesion, the extension of pancreatic resection, and the requirement for an extended procedure to adjacent organs were signifcantly associated with the risk of conversion to the open approach. Multivariate analysis showed that only the extension of the pancreatic resection (subtotal pancreatectomy) was signifcantly related to the odds of conversion [odds ratio (OR) 19.5; 95% confdence interval (CI) 1.1–32.3; P = 0.038]. Preoperative suspi- cion of malignancy difered between the two groups; however, this diference did not reach statistical signifcance (P = 0.078). Conclusions Despite the limitations of the study, only the extension of pancreatic resection seemed to be the main factor related to conversion during laparoscopic distal pancreatectomy. Keywords Pancreas · Laparoscopic distal pancreatectomy · Open distal pancreatectomy · Conversion · Pancreatic resection Laparoscopic distal pancreatectomy (LDP) has become an increasingly adopted technique, and recent systematic reviews and meta-analyses have demonstrated its feasibility and safety for both benign and malignant pancreatic lesions, reporting postoperative outcomes at least comparable to those obtained with the open approach [1–7]. Nevertheless, LDP remains a difcult surgical procedure with technical limitations as well as a limited range of motion, 2-dimen- sional visualization, and difculty controlling large blood vessels. The higher conversion rate reported (mean 22%; range 0–66%) [8] from laparoscopic to open distal pancrea- tectomy with respect to other advanced laparoscopic proce- dures, as well as colectomy (6%) [9] or adrenalectomy (3%) [10], is an evident demonstration of its difculty. However, the difculty of a surgical procedure is highly subjective and it remains difcult to integrate all the risk factors and an objective prediction of technical difculty. Several authors [11–14] believe that difcult laparoscopic procedures are associated with a high rate of conversion to laparotomy. Regarding the other advanced laparoscopic procedures, using a large national database, several factors related to conversion have been reported; for instance, for colec- tomy, age over 50 years, obese patients, American Society and Other Interventional Techniques Authorship: All the authors have participated equally in the study according to the guidelines of the International Committee of Medical Journal Editors (ICMJE). * Riccardo Casadei riccardo.casadei@unibo.it 1 Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Alma Mater Studiorum, Università di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy 2 Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Chirurgia Generale-Prof. Minni, Alma Mater Studiorum, Università di Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n.9, 40138 Bologna, Italy