Laparoscopic Rectal Resection for Cancer: Effects of Conversion on Short-Term Outcome and Survival

Rottoli, Matteo; Bona, Stefano; Rosati, Riccardo; Elmore, Ugo; Bianchi, Paolo Pietro; Spinelli, Antonino; Bartolucci, Cristina; Montorsi, Marco

doi:10.1245/s10434-009-0398-4

Cited by 124 publications

(107 citation statements)

References 35 publications

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“…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.…”

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

et al. 2013

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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...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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

et al. 2013

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“…Regarding the small number of patients undergoing IA after SIL-RH, no conclusion could be reached regarding the most appropriate type of anastomosis after SIL-RH. Conversion of a laparoscopic procedure is associated with increased postoperative morbidity [43] as well as LOS [44], compared with planned open procedures. Vettoretto et al [45] in their meta-analysis found no statistically significant difference in the conversion rate between SIL-RH and ML-RH patients.…”

Section: Discussionmentioning

confidence: 99%

Single-Incision Laparoscopic Right Hemi-Colectomy: a Systematic Review

Αποστόλου

Orfanos²,

Papalois

et al. 2015

Indian J Surg

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As surgeons became more adept with laparoscopic colon surgery, other less invasive procedures, such as singleincision laparoscopic right hemi-colectomy (SIL-RH), have been applied. The objective of this study was to evaluate the safety of SIL-RH as well as its intraoperative and postoperative outcomes for right-sided colon diseases. A detailed search in PubMed for citations that included SIL-RH from 2000 to 2014 revealed 21 studies fulfilling the criteria of the present review. A total of 684 patients were analyzed. Of the patients, 50.2 % were men. Mean patient age was 64.8 years. Of the patients, 36.1 % had already undergone an abdominal operation before the performance of SIL-RH, while 69 % of the patients underwent SIL-RH for colon cancer. Relatively low rates of overall morbidity (15 %) and mortality (0.75 %) were reported in the included studies. Mean length of postoperative hospital stay (LOS) was 5.5 days. Bowel motility return had a mean value of 2.8 days. Mean number of harvested lymph nodes (LN) was 19.2 LN. All resection margins were tumorfree. SIL-RH was a safe alternative to multiport laparoscopic right hemi-colectomy (ML-RH) in terms of morbidity and mortality, postoperative gastrointestinal function recovery, LOS, as well as oncological radicalness.

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“…In a classic trial, laparoscopic surgery was associated with increased CRM positivity rates compared with open surgery (12.4% vs. 6.3%). Laparoscopic rectal cancer surgery in particular is associated with a higher conversion rate when compared with colonic laparoscopic resection, and those that are converted to open surgery have a higher mortality rate [5,11] . This is a possible reflection of the technical challenges that confront a surgeon during rectal dissection.…”

Section: Questionable Safety Of Laparoscopic Rectal Dissectionmentioning

confidence: 99%

Is robotic rectal resection the preferred option for resectable cancer?

Chouhan¹,

Shin²,

Kim³

2018

MIS

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The ultimate goal of rectal cancer surgery is to achieve a negative circumferential, distal resection margin and intact mesorectal excision; however, controversy remains as to what is the best approach. Based on the current evidence, open surgery remains the "gold standard", however recent improvements in minimally invasive surgery (MIS) techniques with the introduction of robotic surgery and transanal total mesorectal excision have questioned the historical approach of open rectal dissection. A robotic system (da Vinci) overcomes many of the limitations of laparoscopic surgery. A robotic system is more like an open surgery: it gives a 3-dimensional magnified view, endowrist movements, has a shorter learning curve when compared with laparoscopic surgery, with the added advantage of an MIS procedure. However, the higher cost associated with robotic surgery has limited uptake of this approach in rectal cancer surgery in many parts of world.

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Laparoscopic Rectal Resection for Cancer: Effects of Conversion on Short-Term Outcome and Survival

Abstract: Our study suggests that conversion to open surgery does not affect postoperative outcome, but could have a negative impact on long-term overall recurrence rate. LRR should be performed by experienced surgeons in selected patients.

Cited by 124 publications

References 35 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?

Single-Incision Laparoscopic Right Hemi-Colectomy: a Systematic Review

Is robotic rectal resection the preferred option for resectable cancer?

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