Impact of conversion on outcome in laparoscopic colorectal cancer surgery.

Abstract

IntroductionLong-term results after laparoscopic surgery with conversion to open surgery for colorectal cancer are seldom published.AimThe study analysed the impact of conversion of laparoscopic surgery to open resection for colorectal cancer on short- and long-term results.Material and methodsThe prospectively collected data of 469 patients with colorectal cancer in the period from 1 January 2001 to 31 December 2006 were analysed. Short- and long-term results were compared.ResultsThe relative frequency of conversion was 7%. The subgroups were statistically similar regarding age, gender, body mass index (BMI), localization of tumour, T stage, and TNM stage. We observed a lower frequency of previous surgery (p = 0.018) in the group of patients with conversions to open surgery as well as statistically significantly higher frequency of patients with American Society of Anesthesiologists (ASA) score II (p = 0.039). There was no statistical difference in morbidity, mortality, or the length of hospital stay between both the groups of patients. The operating time was significantly higher in the group of patients with conversion (p = 0.00001). There was a significantly higher blood loss in the patient groups with conversion to open surgery and in the group with primarily open surgery (p = 0.00023). There was no difference in the overall survival (p = 0.712), disease-free survival (p = 0.072) or in the local (p = 0.432) or distant (p = 0.957) recurrence.ConclusionsNo negative impact on short- or long-term results of conversion to open surgery was verified in patients with colorectal surgery.

A meta‐analysis to determine the oncological implications of conversion in laparoscopic colorectal cancer surgery

“…Fifteen published studies containing data on conversion from laparoscopic to open colorectal cancer resection were identified (Table 1) [6,[8][9][10][14][15][16][17][18][19][20][21][22][23][24]. The initial search identified 3051 articles.…”

Conversion during laparoscopic colorectal resections: a complication or a drawback? A systematic review and meta-analysis of short-term outcomes

“…No difference was found in 30-day overall morbidity between COS and POS patients. Previously, two studies found a higher Overall (I−squared = 96.9%, p = 0.000) Rickert et al [34] Kang et al [32] Study Casillas et al [16] Gonzalez et al [18] Bouvet et al [25] Strohlein et al [15] Kaiser et al [26] Martinek et al [28] Slim et al [12] CLASICC trial [3] Begos et al [24] Hewett et al [27] Senagore et al [23] Pennincks et al [31] [3,12], but Slim et al [12] reported data from an early laparoscopic experience. Consistent with this result, there was no difference in the length of postoperative hospital stay.…”

“…Martinek et al [28] Unplanned laparotomy or wound enlargement above the necessity for specimen removal Mroczkowski et al [30] Procedures started in laparoscopic manner and ended in open manner…”

“…4) with no difference between COS and POS (WMD, −0.12; 95 % CI, −1.14 to 0.89; significant heterogeneity Q, 65.10; p=0, I 2 =96.9 %) as for anastomotic leak rate (OR, 1.08; 95 % CI, 0.88 to 1.33) that was recorded in seven studies [3,11,15,24,29,32,34]. Operating time [11, 12, 16, 18, 22, 24-26, 28, 34, 37] [18,22,23,26,28]. Among other secondary outcomes investigated, no differences were found in rates of re-operation, postoperative bleeding, postoperative obstruction, sepsis, cardiac complication, and deep venous thrombosis (Table 4).…”

“…The full text of the remaining 79 articles was examined in more detail. After excluding 59 studies, 20 studies [11,12,15,16,18,[23][24][25][26][27][28][29][30][31][32][33][34][35][36] were included in the meta-analysis (Fig. 1 [11,16,22,26,27].…”