Impact of conversion on the long-term outcome in laparoscopic resection of colorectal cancer

Chan, Albert; Poon, Jensen T. C.; Fan, Jicong; Lo, Siu Hung; Law, Wai Lun

doi:10.1007/s00464-008-9813-3

Cited by 125 publications

(126 citation statements)

References 16 publications

Supporting

Mentioning

111

Contrasting

Unclassified

Order By: Relevance

“…Several studies have investigated the impact that conversion of LCR has on perioperative outcomes. The intraoperative results in our series are consistent with those reported in the literature, with conversion to open surgery leading to a significantly longer operative time and increased blood loss [3,[13][14][15][16][17][18]. Regarding postoperative short-term outcomes, significantly higher morbidity and mortality rates and a prolonged hospital stay are widely reported after conversion of LCR [14,18,29,35,36].…”

Section: Discussionsupporting

confidence: 89%

“…The hospital stay was prolonged in the CONV group (colon cancer patients: 8 vs 7 days; rectal cancer patients: 10 vs 8 days), consistent with the results reported in the literature, although these differences did not reach statistical significance. In nonrandomized comparative and descriptive studies, conversion also is associated with worse oncologic outcomes in terms of higher local recurrence and reduced survival rates [13,16,18,20,21,23]. However, the cited studies present several shortcomings including small sample sizes, short follow-up periods, and lack of adequate statistical analysis that limit the interpretation of the results.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have reported higher morbidity and mortality rates and a longer postoperative hospital stay [3,[13][14][15][16][17][18], whereas others did not find significant differences in comparisons with to non converted patients [12,[19][20][21][22]. The oncologic outcomes for converted patients are poorly investigated, and the data currently available are unclear [10,[12][13][14][15][16][17][18][19][20][21][22][23]. This study aimed to evaluate the impact of conversion to open surgery on short-and long-term outcomes in a large series of patients undergoing laparoscopic resection for nonmetastatic colorectal cancer.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Does conversion affect short-term and oncologic outcomes after laparoscopy for colorectal cancer?

et al. 2013

View full text Add to dashboard Cite

Background Conversion of laparoscopic colorectal resection (LCR) for cancer has been associated with adverse short-term and oncologic outcomes. However, most studies have had small sample sizes and short follow-up periods. This study aimed to evaluate the impact of conversion to open surgery on early postoperative outcomes and survival among patients undergoing LCR for nonmetastatic colorectal cancer. Methods A prospective database of consecutive LCRs for nonmetastatic colorectal cancer was reviewed. Patients who required conversion (CONV group) were compared with those who had completed laparoscopic resection (LAP group). Only patients with a minimum 5-year follow-up period were included in the oncologic analysis. Kaplan-Meier curves were compared to analyze survival. A multivariate analysis was performed to identify predictors of poor survival. Results The conversion rate was 10.9 %. The most common reason for conversion was a locally advanced tumor (48.4 %). Conversion was associated with a significantly longer operative time and a greater blood loss. No differences were observed in terms of postoperative morbidity, mortality, or hospital stay between the CONV and LAP patients. During a median follow-up period of 120 months (range, 60-180 months), the CONV group had a significantly worse 5-year overall survival (OS) (79.4 vs 87.4 %; p = 0.016) and disease-free survival (DFS) (65.4 vs 79.6 %; p = 0.013). Univariate analysis showed that conversion to open surgery, postoperative complications, anastomotic leakage, pT4 cancer, stage 3 disease, and adjuvant chemotherapy were significant risk factors for OS and DFS. On multivariate analysis, pT4 cancer and a lymph node ratio (LNR) of 0.25 or greater were the only independent predictors of DFS and OS, whereas a LNR of 0.01 to 0.24 showed a trend that did not reach statistical significance. Recent large RCTs [5,6] as well as a systematic review and metaanalysis of the literature [7] have reported similar advantages of laparoscopic rectal resection and total mesorectal excision (TME) compared with open surgery for extraperitoneal rectal cancer. Evidence from the literature also has shown comparable outcomes in terms of oncologic clearance and long-term survival between laparoscopic and open resection for colon [1,[8][9][10] and rectal cancer [10][11][12]. The rates for conversion of laparoscopic colon resection to open surgery reported in the largest multicenter RCTs range from 17 to 25 % [2-4], whereas the conversion rates for laparoscopic rectal resection vary between 0.6 and 32.4 % [7]. With the exception of the conventional versus laparoscopic-associated surgery in colorectal cancer (CLASICC) trial, all RCTs have analyzed converted patients in the laparoscopic group on an "intention-to-treat" basis. A few nonrandomized studies have examined the short-term outcomes for converted cancer patients. Some studies have reported higher morbidity and mortality rates and a longer postoperative hospital stay [3,[13][14][15][16][17][18], whereas others did not find si...

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Does conversion affect short-term and oncologic outcomes after laparoscopy for colorectal cancer?

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Vascular pedicles were treated intracorporeally. Conversion was defined as any incision performed to complete the surgery not exclusively with the purpose of removing the surgical tool [33].…”

Section: Methodsmentioning

confidence: 99%

Enhanced Recovery After Surgery (ERAS) Implementation of a Protocol in Laparoscopic Colectomy, Initial Experience in a Single Institution in Argentina

Uriburu¹

2016

GHOA

View full text Add to dashboard Cite

show abstract

“…The postoperative outcomes of patients undergoing conversion are also not clear: when conversion cases are compared with laparoscopy and open surgery cases, exact data on operation time, hospitalization duration, morbidity, mortality and oncologic outcomes is not yet available. 8,9,10 Consequently, there is ongoing debate about whether laparoscopic interventions should be recommended to all patients with colorectal pathology, and how to identify patients at risk of conversion. In this retrospective study, we aimed to compare the short and long-term outcomes of cases converted from laparoscopy to open surgery with other methods (laparoscopy and open surgery) over a three-year follow-up period.…”

mentioning

confidence: 99%

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

Erdoğdu¹,

Çaycı²

2018

TJCD

View full text Add to dashboard Cite

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,...

show abstract

Impact of conversion on the long-term outcome in laparoscopic resection of colorectal cancer

Abstract: The disease-free survival and the local recurrence were significantly worse by the presence of conversion in laparoscopic resection for colorectal malignancy. Adoption of a standardized operative strategy may improve the perioperative outcome after conversion.

Cited by 125 publications

References 16 publications

Does conversion affect short-term and oncologic outcomes after laparoscopy for colorectal cancer?

Does conversion affect short-term and oncologic outcomes after laparoscopy for colorectal cancer?

Enhanced Recovery After Surgery (ERAS) Implementation of a Protocol in Laparoscopic Colectomy, Initial Experience in a Single Institution in Argentina

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

Contact Info

Product

Resources

About