Does the number of operating specialists influence the conversion rate and outcomes after laparoscopic colorectal cancer surgery?
- 144 Downloads
Laparoscopic techniques in colorectal surgery have been widely utilised due to short-term patient benefits but conversion to open surgery is associated with adverse short- and long-term patient outcomes. The aim of this study was to investigate the influence of dual specialist operating on the conversion rate and patient outcomes following laparoscopic colorectal surgery.
A prospectively populated colorectal cancer surgery database was reviewed. Cases were grouped into single or dual consultant procedures. Cluster analysis and odds ratio (OR) were used to identify risk factors for conversion. Primary outcome measures were conversion to open and five year overall survival (OS) calculated using the Kaplan–Meier log-rank method.
750 patients underwent laparoscopic colorectal cancer resection between 2002 and 2015 (median age 73, 319 (42.5%) female, 282 (37.6%) rectal malignancies, 135 patients (18%) had two consultants). The single surgeon conversion rate was 20.4% compared to 5.5% for dual operating (OR 4.4, 95% CI 1.87–10.2, p < 0.001). There were no demographic or tumour differences between the laparoscopic/converted and number of surgeon groups. Two-step cluster analysis identified cluster I (lower risk) 406 patients, 8% converted and cluster II (higher risk) 261 patients, conversion rate 30%. Median follow-up was 48 months (range 0–168). Five-year OS was significantly inferior for both converted and single surgeon cases (63% vs. 77%, p < 0.001 and 61% vs. 70%, p = 0.033, respectively).
In selected colorectal cancer patients operated by fully trained laparoscopic surgeons, we observed a reduction in conversion with associated long-term survival benefit from dual operating specialists.
KeywordsConversion Colorectal cancer Survival Laparoscopy
Compliance with ethical standards
Prof. Francis, Mr. Curtis, Dr. Crilly, Miss. Noble, Dr. Dyke, Mr. Hipkiss, Mr. Dalton, Mr. Allison, Dr. Salib and Mr. Ockrim confirm they have no conflicts of interest or financial ties to disclose.
- 7.Collinson FJ, Jayne DG, Pigazzi A, Tsang C, Barrie JM, Edlin R et al (2012) An international, multicentre, prospective, randomised, controlled, unblinded, parallel-group trial of robotic-assisted versus standard laparoscopic surgery for the curative treatment of rectal cancer. Int J Colorectal Dis 27(2):233–241CrossRefPubMedGoogle Scholar
- 17.Healthcare Quality Improvement Partnership. UK National Bowel Cancer Audit Annual Report 2016. 2017. NHS Digital. 3-5-2017Google Scholar
- 19.Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M et al (2015) Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA 314(13):1346–1355CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Jimenez C, Kaspar K, Rivera J, Talone A, Jentsch F (2016) Crew resource management. In: Proceedings of the human factors and ergonomics society annual meeting, vol 59, pp 946–950Google Scholar