High morbidity rate after converted laparoscopic colorectal surgery

Slim, K.; Pezet, Denis; Y, Riff; Clark, E; Chipponi, J

doi:10.1002/bjs.1800821036

Cited by 108 publications

(69 citation statements)

References 17 publications

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“…Likewise, reported incidences of anastomosis leakage are 2.4-6.8% after open surgery, 2.7% after laparoscopy, but 25% after conversion. 25,31 However, in our study, anastomosis leakage was observed in laparoscopy and open surgery groups but not in the conversion group. In conversion patients, the incidence of mortality is reported to be 3.5%.…”

contrasting

confidence: 69%

“…When the outcomes of patients undergoing laparoscopy or conversion surgery are compared, a higher rate of morbidity is seen in both groups compared to those having open surgery, according to the literature. 25 While no difference in terms of morbidity and mortality are reported between conversion patients and the open surgery group in this report, another study reports a higher complication rate and a longer period of hospitalization in conversion patients compared to those having laparoscopy or open surgery. 8,26 The morbidity rate is reported as 23% after laparoscopy, 11-20% after open surgery, and 35.2% after conversion.…”

contrasting

confidence: 58%

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The Effect of Resection Methods on Outcomes in Colorectal Cancers: Does Conversion Matter?

Erdoğdu¹,

Çaycı²

2018

TJCD

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ÖZAmaç: Çalışmamızda kolorektal kanserlerde laparoskopiden açığa konversiyon ve diğer yöntemlerin (laparoskopi ve açık cerrahi) kısa ve uzun dönemde sonuçlarının değerlendirilmesi amaçlanmıştır. Yöntem: Kolorektal kanser nedeniyle aynı merkezde elektif opere edilen 98 hastanın medikal verileri retrospektif olarak değerlendirildi. Hastalar rezeksiyon metoduna göre laparoskopi (n=44), açık (n=43) ve konversiyon (n=11) olarak üç gruba ayrıldı. Gruplarda hastaların demografik özellikler, komorbidite varlığı, tümörün kolonik yerleşimi, kolonoskopide geçiş özellikleri, preoperatif metastaz, rezeksiyon tipi, morbidite ve mortalite, lenf bezi metastazı ve hastalık evresi, takip süreleri, nüks ve genel sağkalım verileri kaydedildi ve karşılaştırıldı. Bulgular: Morbidite en sık konversiyon grubunda (%63,6) olduğu görüldü (p=0,012). Morbidite alt grup analizleri yapıldığında laparoskopi ve open cerrahi grupları arasında istatistiksel farklılık bulunmazken (p=0,752); konversiyon grubunda morbidite görülme oranı hem laparoskopi grubundan hem de open cerrahi grubundan istatistiksel olarak daha yüksek bulundu (sırasıyla p=0,009 ve p=0,025). Takip döneminde nüks laparoskopi grubunda 2 (%4,50) hastada, open cerrahi grubunda 2 (%4,50) hastada görüldü. Konversiyon grubunda hastalık nüksü görülmedi. Bir, iki ve üç yıllık sağkalım açısından gruplar arasında farklılık görülmedi. Sonuç: Kolorektal kanserlerde erken dönemde konversiyon uygulanan hastalarda morbidite daha sık görülmekte; ancak kısa ve uzun dönem onkolojik sonuçlarda rezeksiyon metodları arasında farklılık bulunmamaktadır. Anahtar Kelimeler: Kolorektal kanser, laparoskopi, açık cerrahi, konversiyon Aim: In this study, we aimed to evaluate the short-and long-term outcomes of patients undergoing conversion from laparoscopy to open surgery compared to other methods (laparoscopy and open surgery). Method: The data of 98 patients who underwent elective surgery due to colorectal cancer in a single center were retrospectively analyzed. Based on the resection method, patients were divided into three groups: laparoscopy (n=44), open (n=43), and conversion (n=11). The demographic characteristics, comorbidity, colonic localization, colonic transit properties, preoperative metastasis, resection type, morbidity and mortality, lymph node metastasis, stage, follow-up duration, recurrence, and overall survival data were recorded and compared. Results: The morbidity incidence was highest in the conversion group (63.6%) (p=0.012). There was no statistical difference in the morbidity subgroup analyses between laparoscopy and open surgery groups (p=0.752), whereas the incidence of morbidity in the conversion group was statistically higher than both the laparoscopy and open surgery groups (p=0.009 and p=0.025, respectively). During follow-up, recurrence was observed in two patients (4.50%) in the laparoscopy group and in two patients (4.50%) in the open surgery group. There was no difference in one, two, and three-year survival rates among the three groups. Conclusion: In colorectal cancers,...

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contrasting

confidence: 69%

contrasting

confidence: 58%

The Effect of Resection Methods on Outcomes in Colorectal Cancers: Does Conversion Matter?

Erdoğdu¹,

Çaycı²

2018

TJCD

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“…In general, higher complication rates have been noted in patients that required conversions during laparoscopic cholecystectomy, appendectomy and colectomy as compared to the open approach [31][32][33][34]. However, Slim et al [35] found that while the conversion generally resulted in an inferior outcome compared to that reported for open colorectal surgery, none of the patients who underwent a conversion at an early stage experienced a complicated postoperative course. Their findings conclusively demonstrate that an early decision to abandon the laparoscopic approach is the key to avoiding serious adverse events.…”

Section: Discussionmentioning

confidence: 99%

Single-institute prospective trial of laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma

et al. 2011

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Background Laparoscopy-assisted gastrectomy (LAG) is an advanced surgery that requires the mastery of complex surgical skills. We evaluate the feasibility of LAG with systemic lymph node dissection when participating surgeons have sufficient knowledge and experience to conduct open surgery for gastric cancer and basic laparoscopic skills. Methods All operations were performed by two Japan Surgical Society board-certified attending surgeons who had performed over 50 conventional gastrectomies and 30 laparoscopic cholecystectomies. The surgeons went through an established program, including training at the wet and dry laboratories. In addition, surgeries for the first 10 cases were assisted by an expert surgeon with experience of [300 cases. To be eligible for the LAG procedure, patients had to have a preoperative diagnosis of T1, N0 and M0 gastric carcinoma. The morbidity rate was used as the study endpoint. Variables such as operating time, intraoperative blood loss and number of retrieved lymph nodes were evaluated as complementary surgical endpoints. These variables were compared between the first 25 cases and the latter 25 cases.Results A total of 50 patients who were scheduled to undergo LAG were prospectively enrolled between 2005 and 2008. Morbidity rate was 4% (2/50), with one case due to intestinal injury and one case due to an intra-abdominal abscess. Complications related to laparoscopy were observed in 2% (1/50), with one case of mesenteric injury. The conversion rate to laparotomy was 6% (3/50). However, there were no serious consequences in converted cases. The operating time was 263.7 ± 45.0 min. The intraoperative blood loss was 94.5 ± 106.5 g. The total number of regional lymph nodes retrieved was 34.7 ± 12.2. A significant improvement in the blood loss was only noted after the first 25 procedures. All patients are alive and disease-free after a median follow-up of 38.8 months. Conclusion An adequate training program, including site visits by expert surgeons, in conjunction with basic laparoscopy skills and solid backgrounds in open gastrectomy from the perspective of the trainees are currently key to the successful and safe implementation of LAG. Whether the procedure is oncologically feasible remains to be confirmed by long-term follow-up.

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“…Not surprising, studies found longer operating times and higher risk of conversion with associated morbidity. [37][38][39][40] However, with increased laparoscopic experience, refinement in technique, and advances in surgical technology, the indications broadened. Laparoscopic resection was demonstrated to be feasible and safe in recurrent uncomplicated disease.…”

Section: Management Of Diverticular Diseasementioning

confidence: 99%

Laparoscopic Management of Diverticular Colovesical Fistula: Experience in 15 Cases and Review of the Literature

Marney

2013

International Surgery

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Colovesical fistulas secondary to diverticular disease may be considered a contraindication to the laparoscopic approach. The feasibility of laparoscopic management of complicated diverticulitis and mixed diverticular fistulas has been demonstrated. However, few studies on the laparoscopic management of diverticular colovesical fistulas exist. A retrospective analysis was performed of 15 patients with diverticular colovesical fistula, who underwent laparoscopic-assisted anterior resection and bladder repair. Median operating time was 135 minutes and median blood loss, 75 mL. Five patients were converted to an open procedure (33.3%) with an associated increase in hospital stay (P ¼ 0.035). Median time to return of bowel function was 2 days and median length of stay, 6 days. Overall morbidity was 20% with no major complications. There was no mortality. There was no recurrence during median follow-up of 12.4 months. These results suggest that laparoscopic management of diverticular colovesical fistulas is both feasible and safe in the setting of appropriate surgical expertise.

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High morbidity rate after converted laparoscopic colorectal surgery

Cited by 108 publications

References 17 publications

The Effect of Resection Methods on Outcomes in Colorectal Cancers: Does Conversion Matter?

The Effect of Resection Methods on Outcomes in Colorectal Cancers: Does Conversion Matter?

Single-institute prospective trial of laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma

Laparoscopic Management of Diverticular Colovesical Fistula: Experience in 15 Cases and Review of the Literature

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