Abstract
Background
Long-term outcome of patients with conversion following laparoscopic resection of colorectal cancer has seldom been reported. This study aimed to evaluate the impact of conversion on the operative outcome and survival of patients who underwent laparoscopic resection for colorectal malignancy.
Methods
An analysis of a prospectively collected database of 470 patients who underwent laparoscopic colectomy between May 2000 and December 2006 was performed. The operative results and long-term outcomes of patients with conversion were compared with those with successful laparoscopic operations.
Results
The overall conversion rate to open surgery was 8.7% (41 patients). There was no difference in age, comorbid illness, location of tumor, and stage of disease between the laparoscopic and conversion groups. The most common reasons for conversion include adhesions (34.1%), tumor invasion into adjacent structures (17.1%), bulky tumor (9.8%), and uncontrolled hemorrhage (9.8%). A male preponderance was observed in the conversion group. Tumor size was significantly larger in the conversion group compared with the laparoscopic group (5 versus 4 cm, P = 0.002). Although there was no difference in the operative time between the two groups, increased perioperative blood loss (461.9 vs. 191.2 ml, P < 0.001), increased postoperative complication rate (56.1% versus 16.7%, P = 0.001) and prolonged median hospital stay (10 versus 6 days, P < 0.001) were associated with the conversion group. Consequently, patients in the conversion group were more likely to develop local recurrence (9.8% versus 2.8%, P < 0.001) with a significantly reduced cumulative cancer-free survival.
Conclusion
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.
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References
Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726
Veldkamp R, Kuhry E, Hop WC et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6(7):477–484
Moloo H, Mamazza J, Poulin EC et al (2004) Laparoscopic resections for colorectal cancer: does conversion survival? Surg Endosc 18(5):732–735
Bennett CL, Stryker SJ, Ferreira MR et al (1997) The learning curve for laparoscopic colorectal surgery. Preliminary results from a prospective analysis of 1194 laparoscopic-assisted colectomies. Arch Surg 132(1):41–44; discussion 45
Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242(1):83–91
Gervaz P, Pikarsky A, Utech M et al (2001) Converted laparoscopic colorectal surgery. Surg Endosc 15(8):827–832
Schlachta CM, Mamazza J, Seshadri PA et al (2000) Predicting conversion to open surgery in laparoscopic colorectal resections. A simple clinical model. Surg Endosc 14(12):1114–1117
Gonzalez R, Smith CD, Mason E et al (2006) Consequences of conversion in laparoscopic colorectal surgery. Dis Colon Rectum 49(2):197–204
Tekkis PP, Senagore AJ, Delaney CP (2005) Conversion rates in laparoscopic colorectal surgery: a predictive model with, 1253 patients. Surg Endosc 19(1):47–54
Casillas S, Delaney CP, Senagore AJ et al (2004) Does conversion of a laparoscopic colectomy adversely affect patient outcome?. Dis Colon Rectum 47(10):1680–1685
Belizon A, Sardinha CT, Sher ME (2006) Converted laparoscopic colectomy: what are the consequences? Surg Endosc 20(6):947–951
Marusch F, Gastinger I, Schneider C et al (2001) Importance of conversion for results obtained with laparoscopic colorectal surgery. Dis Colon Rectum 44(2):207–214; discussion 214–6
Kiran RP, Delaney CP, Senagore AJ et al (2004) Operative blood loss and use of blood products after laparoscopic and conventional open colorectal operations. Arch Surg 139(1):39–42
Agachan F, Joo JS, Sher M et al (1997) Laparoscopic colorectal surgery. Do we get faster? Surg Endosc 11(4):331–335
Senagore AJ, Delaney CP, Brady KM, Fazio VW (2004) Standardized approach to laparoscopic right colectomy: outcomes in 70 consecutive cases. J Am Coll Surg 199(5):675–679
Senagore AJ, Duepree HJ, Delaney CP et al (2003) Results of a standardized technique and postoperative care plan for laparoscopic sigmoid colectomy: a 30-month experience. Dis Colon Rectum 46(4):503–509
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Chan, A.C.Y., Poon, J.T.C., Fan, J.K.M. et al. Impact of conversion on the long-term outcome in laparoscopic resection of colorectal cancer. Surg Endosc 22, 2625–2630 (2008). https://doi.org/10.1007/s00464-008-9813-3
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DOI: https://doi.org/10.1007/s00464-008-9813-3