The Impact of Laparoscopic Converted to Open Colectomy on Short-Term and Oncologic Outcomes for Colon Cancer

Li, Jian; Hui, Guo; Guan, Xiaodong; Cai, Chaonong; Yang, Lukun; Yue-chan, LI; Zhu, Yanhua; Li, Pei-Ping; Liu, Xia-Lei; Yang, Dongjie

doi:10.1007/s11605-014-2685-z

Cited by 27 publications

(46 citation statements)

References 32 publications

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“…Based on the in- and exclusion criteria, all articles were subsequently selected on title, abstract and full-text. Eventually, 18 studies were selected for inclusion in this review: 12 prospective[ 12 , 15 - 17 , 19 - 22 , 24 - 26 , 28 ], five retrospective cohort studies[ 13 , 14 , 18 , 23 , 29 ] and one prospective case-control study[ 27 ].…”

Section: Resultsmentioning

confidence: 99%

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Conversion of laparoscopic colorectal resection for cancer: What is the impact on short-term outcomes and survival?

Allaix

Furnée

Mistrangelo

et al. 2016

WJG

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Laparoscopic resection for colon and rectal cancer is associated with quicker return of bowel function, reduced postoperative morbidity rates and shorter length of hospital stay compared to open surgery, with no differences in long-term survival. Conversion to open surgery is reported in up to 30% of patients enrolled in randomized control trials comparing open and laparoscopic colorectal resection for cancer. In this review, reasons for conversion are anatomical-related factors, disease-related-factors and surgeon-related factors. Body mass index, local tumour extension and co-morbidities are independent predictors of conversion. The current evidence has shown that patients with converted resection for colon cancer have similar outcomes compared to patients undergoing a laparoscopic completed or open resection. The few studies that have assessed the outcomes after conversion of laparoscopic rectal resection reported significantly higher rates of complications and longer length of hospital stay in converted patients compared to laparoscopically treated patients. No definitive conclusions can be drawn when converted and open rectal resections are compared. Early and pre-emptive conversion appears to have more favourable outcomes than reactive conversion; however, further large studies are needed to better define the optimal timing of conversion. With regard to long-term oncologic outcome, overall and disease-free survival in the case of conversion in laparoscopic colorectal cancer surgery seems to be worse than those achieved in patients in whom resection was successfully completed by laparoscopy. Although a worse long-term oncologic outcome has been suggested, it remains difficult to draw a proper conclusion due to the heterogeneity of the long-term outcomes as well as the inclusion of both colon and rectal cancer patients in most of the studies. Therefore, we discuss the currently available evidence of the impact of conversion in laparoscopic resection for colon and rectal cancer on both short-term outcomes and long-term survival.

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Section: Resultsmentioning

confidence: 99%

“…Most studies included colon as well as rectal cancer patients. Three studies only included colon cancer patients[ 23 , 25 , 29 ] and five only included rectal cancer patients[ 14 , 22 , 26 , 20 , 28 ]. Overall, a total number of 53329 patients were included in all individual studies.…”

Section: Resultsmentioning

confidence: 99%

Conversion of laparoscopic colorectal resection for cancer: What is the impact on short-term outcomes and survival?

Allaix

Furnée

Mistrangelo

et al. 2016

WJG

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“…In multivariate analysis, however, only pathologic T4 stage and tumor-positive lymph node ratio > 0.25 were independently associated with OS and DFS. The prospective database study of Li et al showed a similar 5-year DFS and OS in the converted group compared to the laparoscopic completed group and open resection group [35]. It is important to emphasize that pT4 stage was included in all three studies.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic conversion in colorectal cancer surgery; is there any improvement over time at a population level?

et al. 2018

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Conversion of laparoscopic colorectal cancer resection has been associated with worse outcome, but this might have been related to a learning curve effect. This study aimed to evaluate incidence, predictive factors and outcomes of laparoscopic conversion after the implementation phase of laparoscopic surgery at a population level. Patients undergoing elective resection of non-locally advanced, non-metastatic colorectal cancer between 2011 and 2015 were included. Data were extracted from the Dutch Surgical Colorectal Audit. Patients were grouped as laparoscopic completed (LR), laparoscopic converted (CONV) with further specification of timing (within or after 30 min) as registered in the DSCA, and open resection (OR). Uni- and multi-variate analyses were used to determine predictors of conversion and outcome (complicated course and mortality), with evaluation of trends over time. A total of 23,044 patients with colon cancer and 11,324 with rectal cancer were included. Between 2011 and 2015, use of laparoscopy increased from 55 to 84% in colon cancer, and from 49 to 89% in rectal cancer. Conversion rates decreased from 11.8 to 8.6% and from 13 to 8.0%, respectively. Laparoscopic hospital volume was independently associated with conversion rate. Only for colon cancer, the rate of complicated course was significantly higher after CONV compared to OR (adjusted odds ratio 1.486; 95% CI 1.298–1.702), and significantly higher after late (> 30 min) compared to early conversion (adjusted odds ratio 1.341; 1.046–1.719). There was no impact of CONV on mortality in both colon and rectal cancer. The use of laparoscopic colorectal cancer surgery increased to more than 80% at a national level, accompanied by a decrease in conversion which is significantly related to the laparoscopic hospital volume. Conversion was only associated with complicated course in colon cancer, especially when the reason for conversion consisted of an intra-operative complication, without affecting mortality.Electronic supplementary materialThe online version of this article (10.1007/s00464-018-6042-2) contains supplementary material, which is available to authorized users.

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“…The authors found a similar disease-free survival and overall survival between their laparoscopic, converted, and open colectomy cohorts. 10 Given the small sample size in their analysis, they were likely underpowered to show any difference among their three groups. Additionally, this study included patients from two high-volume institutions in China, which potentially limits the generalizability of these results to the US population.…”

Section: Discussionmentioning

confidence: 99%

Does Conversion in Laparoscopic Colectomy Portend an Inferior Oncologic Outcome? Results from 104,400 Patients

Yerokun

Adam

Sun

et al. 2016

Journal of Gastrointestinal Surgery

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Background Limited data exist regarding the effect of conversion from laparoscopic to open colectomy on perioperative and oncologic outcomes in colon cancer. Study Design The National Cancer Data Base was used to identify patients who underwent colectomy for non-metastatic colon cancer (2010–2012). Patients were stratified into three groups: laparoscopic/robotic-assisted colectomy (MIC), converted colectomy (CC), and open colectomy (OC). Multivariable modeling was applied to compare outcomes from CC and MIC to OC while adjusting for patient, clinical, and tumor characteristics. Results Of 104,400 patients, 40,328 (38.6 %) underwent MIC, 57,928 (55.5 %) OC, and 6144 (5.9 %) CC. After adjustment, the rate of positive surgical margins was not significantly different between CC and OC (p = 0.44). However, with adjustment, CC versus OC was associated with shorter hospital length of stay (4 % decrease, 95 % CI 2–5 %, p < 0.0001) and lower odds of 30-day mortality (OR 0.77, 95 % CI 0.64–0.94, p = 0.0112). Adjusted overall survival was similar between CC and OC (p = 0.34). Conclusions Conversion from laparoscopic to open colectomy was not associated with compromised oncologic outcomes, while maintaining improved short-term outcomes despite being attempted in only 45 % of patients. This data suggests that utilization of laparoscopic colectomy should be attempted for patients with colon cancer.

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The Impact of Laparoscopic Converted to Open Colectomy on Short-Term and Oncologic Outcomes for Colon Cancer

Abstract: Conversion to open colectomy from an initial laparoscopic approach does not worsen the long-term survival in patients with non-metastatic colon cancer.

Cited by 27 publications

References 32 publications

Conversion of laparoscopic colorectal resection for cancer: What is the impact on short-term outcomes and survival?

Conversion of laparoscopic colorectal resection for cancer: What is the impact on short-term outcomes and survival?

Laparoscopic conversion in colorectal cancer surgery; is there any improvement over time at a population level?

Does Conversion in Laparoscopic Colectomy Portend an Inferior Oncologic Outcome? Results from 104,400 Patients

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