A risk-based framework to support conversion decision-making during minimally invasive left pancreatectomy: results from a multicentre registry

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.

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Journal
Updates in Surgery
Published
2026-03-31
DOI
https://doi.org/10.1007/s13304-026-02632-8
Primary Topic
Pancreatic and Hepatic Oncology Research
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article
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article

A risk-based framework to support conversion decision-making during minimally invasive left pancreatectomy: results from a multicentre registry

Luca Tirloni, Donata Campra, Laura Mastrangelo, Leonardo Vincenti et al.
Updates in Surgery
Pancreatic and Hepatic Oncology Research
article

A risk-based framework to support conversion decision-making during minimally invasive left pancreatectomy: results from a multicentre registry

Luca Tirloni, Donata Campra, Laura Mastrangelo, Leonardo Vincenti, G C Ferrari, Felice Borghi, Gianluca Garulli, Marco Massani, Sergio Calamia, Raffaele Romito, A. Maffongelli, Davide Citterio, Luca Moraldi, Salvatore Paiella, Giovanni Domenico Tebala, Antonio Giuliani, Carlo Molino, Greta Donisi, Marco Garatti, Niccolò Napoli, Naomi Ingaglio, Adelmo Antonucci, Massimo Viola, Gianandrea Baldazzi8, Umberto Bracale, Giuseppe Maria Ettorre, Alessandro Ferrero, Roberto Salvia, Sergio Alfieri, Ugo Boggi, Riccardo Memeo, Luca Morelli, Massimo Falconi, Renato Romagnoli, Umberto Cillo, Maria Luisa Boella, Elio Jovine, Giovanni Marchegiani, Annalisa Comandatore, Alessandro Zerbi, Raffaele Dalla Valle, Stefano Partelli, Alessia Ripolli, Erica Secchettin, Alessandro Giardino, Claudio Ricci, Giovanni Butturini, Alessandro Esposito, Riccardo Casadei, IGOMIPS Registry Study Group, Salvatore Gruttadauria, Lorenzo De Franco, Andrea Coratti, Giorgio Ercolani, Fabrizio Di Benedetto, Matteo De Pastena, Giovanni Capretti
article en

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.

Updates in Surgery
Università Cattolica del Sacro Cuore (IT), University of Pisa (IT), University of Verona (IT), University of Modena and Reggio Emilia (IT), Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT), University of Parma (IT), Libera Università Maria SS. Assunta (IT), Humanitas University (IT), University of Padua (IT), Vita-Salute San Raffaele University (IT), Agostino Gemelli University Polyclinic (IT), University of Catania (IT), Ospedale Cisanello (IT), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Ospedale Antonio Cardarelli (IT), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), AULSS 2 Marca Trevigiana (IT), Casa di Cura Villa Garda (IT), Department of Medical Sciences (RU), Azienda Ospedaliera S.Giuseppe Moscati (IT), Azienda Ospedaliero-Universitaria Careggi (IT), Federico II University Hospital (IT), Azienda USL di Bologna (IT), Azienda Ospedaliero Universitaria Maggiore della Carita (IT), Azienda Ospedaliera S.Maria (IT), Ospedale G.B. Morgagni - L.Pierantoni (IT), Ospedale Infermi di Rimini (IT), Ospedale Misericordia - Grosseto (IT), Ospedale Generale Regionale Francesco Miulli (IT), Fondazione Poliambulanza Istituto Ospedaliero (IT), Ospedale Sant'Anna (IT), Candiolo Cancer Institute (IT), Carlo Forlanini Hospital (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Gastroenterology Hospital "Saverio de Bellis" (IT), Fondazione IRCCS Istituto Nazionale dei Tumori (IT), Azienda Ospedaliera Ospedale Civile di Legnano (IT), IRCCS Humanitas Research Hospital (IT), Pancreas Centre (Canada) (CA), Azienda Ospedaliera Universitaria Pisana (IT), Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IT), University of Naples Federico II (IT), University of Bologna (IT)
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