A risk-based framework to support conversion decision-making during minimally invasive left pancreatectomy: results from a multicentre registry
Year: 2026
Type: article
Study design: Observational Study
Abstract: Minimally invasive left pancreatectomy (MILP) is increasingly adopted worldwide, but conversion to open surgery still occurs and is associated with poorer postoperative outcomes. Tools to identify patients at increased risk of conversion are limited. This multicentre registry-based study included patients undergoing laparoscopic (LLP) or robot-assisted (RLP) MILP within the IGOMIPS registry. Predictors of conversion were analysed using multivariable logistic regression. A simple preoperative risk score, the modified Conversion Risk Score (mCRS), was derived from independent predictors of conversion. We explored the interaction between preoperative risk, intraoperative complexity, and center-level variability. Of the 2127 MILPs included, 1235 (58.1%) were performed laparoscopically, and 892 (42.9%) were robot-assisted. Conversion occurred in 180 cases (8.5%) and was more frequent during LLP than RLP (11.8% vs 3.8%). Age ≥ 61 years, tumour diameter ≥ 35 mm, and preoperative suspicion of pancreatic malignancy were independently associated with conversion and formed the mCRS (range 0-5). Conversion rates increased progressively with higher mCRS values (ranging from 3.5% to 20.6%). When a high preoperative risk was combined with intraoperative complexity, the probability of conversion increased further (up to 19%). Differences in conversion rates between centres were primarily explained by case volume. In this large multicentre cohort, conversion during MILP was associated with patient age, tumour size, and suspected malignancy. The proposed mCRS, combined with intraoperative cues, may support risk stratification and timely intraoperative decision-making.
Source: Updates in Surgery
Authors: Salvatore Paiella, Matteo De Pastena, Erica Secchettin, Stefano Partelli, Niccolò Napoli, Giovanni Capretti, Sergio Alfieri, Giovanni Butturini, Alessandro Esposito, Massimo Falconi, Roberto Salvia, Alessandro Zerbi, Ugo Boggi, IGOMIPS Registry Study Group, Adelmo Antonucci, Gianandrea Baldazzi, Maria Luisa Boella, Felice Borghi, Umberto Bracale, Sergio Calamia, Donata Campra, Riccardo Casadei, Umberto Cillo, Davide Citterio, Andrea Coratti, Annalisa Comandatore, Raffaele Dalla Valle, Lorenzo De Franco, Fabrizio Di Benedetto, Greta Donisi, Giorgio Ercolani, Giuseppe Maria Ettorre, Giovanni Ferrari, Alessandro Ferrero, Marco Garatti, Gianluca Garulli, Alessandro Giardino, Antonio Giuliani, Salvatore Gruttadauria, Elio Jovine, Naomi Ingaglio, Angela Maffongelli, Giovanni Marchegiani, Marco Massani, Laura Mastrangelo, Riccardo Memeo, Carlo Molino, Luca Moraldi, Luca Morelli, Claudio Ricci, Alessia Ripolli, Renato Romagnoli, Raffaele Romito, Giovanni Domenico Tebala, Luca Tirloni, Leonardo Vincenti, Massimo Giuseppe Viola
Institutions: University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele, University of Pisa, Ospedale Cisanello, Humanitas University, IRCCS Humanitas Research Hospital, Università Cattolica del Sacro Cuore, Agostino Gemelli University Polyclinic, Ospedale P. Pederzoli – Casa di Cura Privata S.p.a., Azienda Socio Sanitaria Territoriale Lariana, Ospedale Sant'Anna, Aziende Socio Sanitarie Territoriale Ovest Milanese, Candiolo Cancer Institute, Federico II University Hospital, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Azienda Ospedaliera Citta' della Salute e della Scienza di Torino, University of Turin, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, University of Bologna, University of Padua, Azienda Ospedale - Università Padova, Fondazione IRCCS Istituto Nazionale dei Tumori, Ospedale Misericordia - Grosseto, University of Parma, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Ospedale G.B. Morgagni - L.Pierantoni, Azienda Ospedaliera San Camillo-Forlanini, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Fondazione Poliambulanza Istituto Ospedaliero, Ospedale Infermi di Rimini, Azienda Ospedaliera S.Giuseppe Moscati, University of Catania, Ospedale Antonio Cardarelli, AULSS 2 Marca Trevigiana, LUM Jean Monnet University, Ospedale Generale Regionale Francesco Miulli, Azienda Ospedaliero-Universitaria Careggi, Azienda Ospedaliero Universitaria Maggiore della Carita, Azienda Ospedaliera S.Maria, Gastroenterology Hospital "Saverio de Bellis", Pia Fondazione di Culto e Religione Azienda Ospedaliera "Card. G. Panico"
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,790
Funder: Università degli Studi di Verona
OpenAlex ID: W7160879595