ORIGINAL RESEARCH article
Front. Oncol.
Sec. Gastrointestinal Cancers: Hepato Pancreatic Biliary Cancers
Preoperative Predictors of Unplanned Conversion in Laparoscopic Liver Resection: A Multicenter Cohort Analysis
Provisionally accepted
Yin Jiang1
Dipesh Kumar Yadav2*Gaoqing Wang1Zhekang Jiang3
Shiwei Zhang1Gong Cheng1
Xinhua Zhou1Haibiao Wang1Hong Li1
Yiren Hu2
Yongfei Hua1- 1Department of Hepatobiliary and Pancreatic Surgery, Ningbo Medical Centre Lihuili Hospital, Ningbo, China
- 2Department of General Surgery, Wenzhou People's Hospital, Wenzhou, China
- 3Department of Health Science Center, Ningbo University, Ningbo, China
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Abstract Objective: To identify preoperative predictors of conversion from laparoscopic to open hepatectomy for optimized patient selection. Methods: This retrospective cohort study analyzed 755 patients undergoing laparoscopic liver tumor resection at two tertiary centers (December 2019–June 2025). Patients were stratified by surgical approach: laparoscopic completion (n=709) versus unplanned conversion (n=46). Univariate analysis was performed using the chi-square (χ²) test for categorical variables and the independent samples t-test for continuous variables. Variables with a p-value < 0.05 were included in multivariate logistic regression analysis to identify independent risk factors for conversion. A p-value of <0.05 was considered statistically significant. Results: The conversion rate was 6.09% (46/755), predominantly due to uncontrolled bleeding (43.5%) and severe adhesions (34.8%). Multivariate analysis identified five independent predictors: history of abdominal surgery (OR=2.12, 95%CI: 1.05–4.26); liver cirrhosis (OR=5.34, 95%CI: 1.80–15.84); postero-superior tumor location (OR=11.36, 95%CI: 5.49–23.52); extended resection (≥3 segments, OR=2.80, 95%CI: 1.22–6.43); and extrahepatic organ resection (OR=4.71, 95%CI: 1.13–19.56). Notably, while larger tumor showed univariate significance (p=0.041), it was not an independent multivariate predictor. Conclusion: Critical preoperative risk factors for conversion include history of abdominal surgery, liver cirrhosis, tumors located in the postero-superior segment, extensive liver resection, and liver resection combined with extrahepatic organ resection. Careful selection of appropriate candidates for laparoscopic liver resection can help reduce the risk of conversion to laparotomy and the occurrence of further complications.
Keywords: conversion, Laparoscopy, liver resection, Liver tumor, Risk factors
Received: 03 Aug 2025; Accepted: 30 Nov 2025.
Copyright: © 2025 Jiang, Yadav, Wang, Jiang, Zhang, Cheng, Zhou, Wang, Li, Hu and Hua. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dipesh Kumar Yadav
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