Patient factors influencing conversion from laparoscopically assisted to open surgery for colorectal cancer

Thorpe, Helen; Jayne, David; Guillou, Pierre J.; Quirke, Philip; Copeland, Joanne

doi:10.1002/bjs.5907

Cited by 128 publications

(87 citation statements)

References 17 publications

(28 reference statements)

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“…Moreover, body mass index was identified as a significant factor for conversion in the context of rectal cancer resection (p = 0.026). 52 The lowest conversion rates were generally observed in trials where a single surgeon or team performed all laparoscopic sur ger ies, 23,24,33,34,36,40,41 suggesting that conversion rate is inversely correlated with surgeon experience. Furthermore, in the CLASICC trial, the conversion rate to open surgery for colorectal cancer decreased as more experience was gained: 38% in the first year of accrual to 16% in the sixth year.…”

Section: Conversion Ratementioning

confidence: 99%

Laparoscopic versus open surgery for the treatment of colorectal cancer: a literature review and recommendations from the Comité de l’évolution des pratiques en oncologie

et al. 2013

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Background: Adoption of the laparoscopic approach for colorectal cancer treatment has been slow owing to initial case study results suggesting high recurrence rates at port sites. The use of laparoscopic surgery for colorectal cancer still raises a number of concerns, particularly with the technique's complexity, learning curve and longer duration. After exploring the scientific literature comparing open and laparoscopic surgery for the treatment of colorectal cancer with respect to oncologic efficacy and shortterm outcomes, the Comité de l'évolution des pratiques en oncologie (CEPO) made recommendations for surgical practice in Quebec.Methods: Scientific literature published from January 1995 to April 2012 was reviewed. Phase III clinical trials and meta-analyses were included.Results: Sixteen randomized trials and 10 meta-analyses were retrieved. Analysis of the literature confirmed that for curative treatment of colorectal cancer, laparoscopy is not inferior to open surgery with respect to survival and recurrence rates. Moreover, laparoscopic surgery provides short-term advantages, including a shorter hospital stay, reduced analgesic use and faster recovery of intestinal function. However, this approach does require a longer operative time.

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Section: Conversion Ratementioning

confidence: 99%

Laparoscopic versus open surgery for the treatment of colorectal cancer: a literature review and recommendations from the Comité de l’évolution des pratiques en oncologie

et al. 2013

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“…A pesar del avance en la técnica y el perfeccionamiento de los crujanos, las distintas series internacionales muestran tasas de conversión que van desde un 2 a un 40% [5][6][7][8][9][10][11][12] . Es aceptado que la conversión no es en sí misma una complicación 11 , sino una herramienta para completar en forma segura un procedimiento, pero su impacto en los resultados está en discusión 7 . La conversión trae consigo la pérdida de los benefi cios de la cirugía mínimamente invasiva y a su vez adiciona los costos del procedimiento 7 .…”

Section: Introductionunclassified

“…Es aceptado que la conversión no es en sí misma una complicación 11 , sino una herramienta para completar en forma segura un procedimiento, pero su impacto en los resultados está en discusión 7 . La conversión trae consigo la pérdida de los benefi cios de la cirugía mínimamente invasiva y a su vez adiciona los costos del procedimiento 7 . Por lo anterior, se ha tratado de defi nir a priori qué pacientes tienen un mayor riesgo de conversión y generar modelos de predicción de este suceso 5,7,8,[10][11][12] .…”

Section: Introductionunclassified

“…La conversión trae consigo la pérdida de los benefi cios de la cirugía mínimamente invasiva y a su vez adiciona los costos del procedimiento 7 . Por lo anterior, se ha tratado de defi nir a priori qué pacientes tienen un mayor riesgo de conversión y generar modelos de predicción de este suceso 5,7,8,[10][11][12] . El objetivo de este trabajo es identifi car los factores de riesgo para la conversión en la cirugía laparoscópica colorrectal en un centro de referencia especializado.…”

Section: Introductionunclassified

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Análisis de los factores predictivos de conversión en cirugía laparoscópica colorrectal

et al. 2011

Rev Chil Cir

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Analysis of predictive factors for conversion to open surgery in laparoscopic colorectal surgeryBackground: Conversion to open surgery of laparoscopic procedures is not in essence a complication, but invalidates the benefi ts of laparoscopy. Aim: To identify the predictive factors for conversion in laparoscopic colorectal surgery. Material and Methods: Revision of medical records of all patients with colorectal disease operated using a laparoscopic approach, from 1998 to 2010. Gender, age, American Society of Anesthesiologists (ASA) score, body mass index (BMI), previous abdominal surgery, elective/urgency procedure, benign/malignant disease, type of resection and surgeon experience were recorded. A logistic regression model was done to determine which variables were predictive for conversion to open surgery. Results: The medical records of 582 patients aged 57 ± 17 years (45% men) were analyzed. The rate of conversion to open surgery was 7.1%. The logistic regression model selected as predictors of conversion a BMI over 25 kg/m

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“…This occurred despite a careful palpation and manipulation during the open procedure and it is reasonable to expect this diffi-culty is magnified with the laparoscopic approach. In fact in a recent review of the CLASICC randomized clinical trial, the extent of tumor spread from the muscularis propria was found to be an independent statistically significant predictor for conversion to an open colectomy [5].…”

Section: Abstract: Colon Cancer Laparoscopic Colectomy Conventionalmentioning

confidence: 99%

Should All Colon Cancer Patients Undergo Laparoscopic Colectomy? The Evidence from the Randomized Clinical Trials

Bozzetti¹

2010

TOCOLCJ

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Although more than 20 years have elapsed since the performance of the first laparoscopic colectomy, the scientific community is still divided between the overoptimistic enthusiasm of surgeons who would apply this procedure to all colon cancers and those who would favor a more prudent and selective approach.In the last years the issue was further complicated by the results of a randomized clinical trial which repeatedly claimed better oncologic results in patients undergoing laparoscopic colectomy as compared with those receiving the traditional open procedure.This short review focuses on the distinct randomized clinical trials comparing the two procedures, the published metaanalyses obtained thereof, in order to comment on the reliability of the studies claiming the evidence of an oncologic benefit with the laparoscopic approach.There is a scientific evidence that in the patients' population eligible for randomization in the published randomized clinical trials the oncologic results appear quite similar.Nothing can be stated for the vast patients' population which did not meet the inclusion criteria in the trial and was therefore excluded.The actual difficulty to generalise the results of randomized clinical trials to all the colon cancer patients suggests a cautious approach to the problem and emphasizes the need of a full explanation to the patients about the limits of the currently available scientific evidence.In the meantime the short-term benefits of the laparoscopic approach have to be weighed against the recent results of the enhanced recovery programmes.

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Patient factors influencing conversion from laparoscopically assisted to open surgery for colorectal cancer

Abstract: Intraoperative conversion is more likely with larger BMI, in men, patients with rectal cancer, those graded ASA III or when there is greater local tumour spread.

Cited by 128 publications

References 17 publications

Laparoscopic versus open surgery for the treatment of colorectal cancer: a literature review and recommendations from the Comité de l’évolution des pratiques en oncologie

Laparoscopic versus open surgery for the treatment of colorectal cancer: a literature review and recommendations from the Comité de l’évolution des pratiques en oncologie

Análisis de los factores predictivos de conversión en cirugía laparoscópica colorrectal

Should All Colon Cancer Patients Undergo Laparoscopic Colectomy? The Evidence from the Randomized Clinical Trials

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