SynthesisAnnals of the Royal College of Surgeons of England2026
Effect of unplanned conversion to open surgery on resection margins and complications in laparoscopic pancreaticoduodenectomy: a systematic review and meta-analysis with meta-regression.
Synthesis in Annals of the Royal College of Surgeons of England, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionWe aimed to investigate the effect of unplanned conversion to open surgery during laparoscopic pancreaticoduodenectomy on resection margins and complications.
methodsA systematic review and meta-analysis (proportion and comparison models) with meta-regression using random-effects modelling compliant with PRISMA statement standards was conducted. All studies with a minimum sample size of 15 patients reporting conversion to open surgery in patients undergoing laparoscopic pancreaticoduodenectomy were included. The outcomes included R0 resection, Clavien-Dindo ≥3 complications, and 30-day mortality.
findingsA total of 44 studies comprising 6,108 patients were included. Conversion occurred in 11.3% (95% confidence interval (CI) 9.1-13.5). The reason for conversion was bleeding in 27.9% (16.3-39.5%), technical difficulties in 46.5% (95% CI 33.7-59.4), oncological concerns in 29.2% (95% CI 18.2-40.2) and iatrogenic injuries in 7.7% (95% CI 3.4-12.1). Multivariable meta-regression analysis showed that conversion did not affect R0 resection (coefficient: -0.228,
conclusionsUnplanned conversion to open surgery, regardless of the reason for conversion, may not affect resection margins and complications in laparoscopic pancreaticoduodenectomy (moderate certainty). Conversion during laparoscopic pancreaticoduodenectomy should not be seen as a failure because it has no negative impact on outcomes; however, not converting when indicated will undoubtedly have negative impact.
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