{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T07:46:28Z","timestamp":1791963988332,"version":"4.3.4"},"reference-count":23,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:00:00Z","timestamp":1787356800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:00:00Z","timestamp":1787356800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Minimally invasive left pancreatectomy (MILP) has become the preferred approach to treat lesions of the pancreatic body and tail. However, the procedure may require conversion to open surgery, with reported conversion rates varying widely in the literature. This study aims to evaluate the incidence, causes, and clinical outcomes associated with conversion to open surgery in a prospective multicenter series.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The SPANDISPAN Project is a prospective, multicenter study conducted at 41 Spanish hospitals from February 2022 to January 2023. Patients were divided into conversion and nonconversion groups to identify predictors using univariate and multivariate logistic regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 313 recorded left pancreatectomies, 217 (69.3%) were MILP procedures. The conversion rate was 10.6%. Reasons for conversion included hemorrhage (60.9%) and intraoperative technical difficulties (39.1%). Multivariable analysis identified intraoperative blood loss (OR 1.65 per 100\u2010mL increment;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) and intraoperative transfusion (OR 7.777;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.012) as independent intraoperative correlates of conversion, reflecting the bleeding\u2010related process leading to conversion rather than preoperative predictors available for case selection. Low center volume was associated with a higher conversion rate in univariable analysis (14.5% vs. 6%;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.042) with a nonsignificant protective trend for high\u2010volume centers after multivariable adjustment (OR 0.339;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.075). Although patients who required conversion had longer operative times and hospital stays, there were no significant differences in major complications, postoperative pancreatic fistula, or mortality between the groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Conversion to open surgery during MILP is primarily driven by intraoperative bleeding\u2010related events rather than by preoperative patient or tumor characteristics. Treatment at a high\u2010volume center was associated with a lower conversion rate, although this trend did not reach significance after multivariable adjustment. Conversion was not associated with a significant increase in major morbidity or mortality in this cohort, supporting its use as a proactive safety measure rather than a surgical failure, although the limited number of conversion events warrants a cautious interpretation of this negative finding.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70531","type":"journal-article","created":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T11:20:37Z","timestamp":1787397637000},"page":"3055-3064","source":"Crossref","is-referenced-by-count":0,"title":["Incidence, Causes, and Outcomes of Conversion to Open Surgery During Minimally Invasive Left Pancreatectomy: A Prospective Multicenter Study"],"prefix":"10.1002","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9559-8692","authenticated-orcid":false,"given":"Ismael","family":"Gomez","sequence":"first","affiliation":[{"name":"Department of Surgery General University Hospital Dr. Balmis  Alicante Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3532-932X","authenticated-orcid":false,"given":"Villodre","family":"C","sequence":"additional","affiliation":[{"name":"Department of Surgery General University Hospital Dr. Balmis  Alicante Spain"},{"name":"Institute of Health and Biomedical Research of Alicante ISABIAL  Alicante Spain"},{"name":"Miguel Hern\u00e1ndez University  Elche Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8737-8126","authenticated-orcid":false,"given":"Hern\u00e1ndez\u2010Roca","family":"B","sequence":"additional","affiliation":[{"name":"Servicio de Cirug\u00eda General Hospital General Universitario de Elda  Alicante Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1920-4674","authenticated-orcid":false,"given":"Rubio\u2010Garc\u00eda","family":"JJ","sequence":"additional","affiliation":[{"name":"Department of Surgery General University Hospital Dr. Balmis  Alicante Spain"},{"name":"Institute of Health and Biomedical Research of Alicante ISABIAL  Alicante Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6685-3135","authenticated-orcid":false,"given":"Juli","family":"Busquets","sequence":"additional","affiliation":[{"name":"H.\u00a0U. Bellvitge L'Hospitalet  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7510-8118","authenticated-orcid":false,"given":"Luis","family":"Secanella","sequence":"additional","affiliation":[{"name":"H.\u00a0U. Bellvitge L'Hospitalet  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuria","family":"Pel\u00e1ez","sequence":"additional","affiliation":[{"name":"H.\u00a0U. Bellvitge L'Hospitalet  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maialen","family":"Alkorta","sequence":"additional","affiliation":[{"name":"H. U. Donostia  San Sebasti\u00e1n Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4343-8243","authenticated-orcid":false,"given":"Itziar","family":"De Ari\u00f1o Hervas","sequence":"additional","affiliation":[{"name":"H. U. Donostia  San Sebasti\u00e1n Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6835-2702","authenticated-orcid":false,"given":"M\u1d43 Mar","family":"Achalandabaso","sequence":"additional","affiliation":[{"name":"H.U. Marqu\u00e9s de Valdecilla  Santander Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8411-5283","authenticated-orcid":false,"given":"Enrique","family":"Toledo","sequence":"additional","affiliation":[{"name":"H.U. 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