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Conversions in laparoscopic surgery for rectal cancer

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Abstract

Background

Laparoscopic surgery offers patients with rectal cancer short-term benefits and similar survival rates as open surgery. However, selecting patients who are suitable candidates for laparoscopic surgery is essential to prevent intra-operative conversion from laparoscopic to open surgery. Clinical and pathological variables were studied among patients who had converted laparoscopic surgeries within the COLOR II trial to improve patient selection for laparoscopic rectal cancer surgery.

Methods

Between January 20, 2004, and May 4, 2010, 1044 patients with rectal cancer enrolled in the COLOR II trial and were randomized to either laparoscopic or open surgery. Of 693 patients who had laparoscopic surgery, 114 (16 %) were converted to open surgery. Predictive factors were studied using multivariate analyses, and morbidity and mortality rates were determined.

Results

Factors correlating with conversion were as follows: age above 65 years (OR 1.9; 95 % CI 1.2–3.0: p = 0.003), BMI greater than 25 (OR 2.7; 95 % CI 1.7–4.3: p < 0.001), and tumor location more than 5 cm from the anal verge (OR 0.5; CI 0.3–0.9). Gender was not significantly related to conversion (p = 0.14). In the converted group, blood loss was greater (p < 0.001) and operating time was longer (p = 0.028) compared with the non-converted laparoscopies. Hospital stay did not differ (p = 0.06). Converted procedures were followed by more postoperative complications compared with laparoscopic or open surgery (p = 0.041 and p = 0.042, respectively). Mortality was similar in the laparoscopic and converted groups.

Conclusions

Age above 65 years, BMI greater than 25, and tumor location between 5 and 15 cm from the anal verge were risk factors for conversion of laparoscopic to open surgery in patients with rectal cancer.

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Funding

Ethicon Endo-Surgery Europe, Swedish Cancer Foundation (2010/593, 2013/497) Region Västra Götaland, Sahlgrenska University Hospital (ALF grants—agreement concerning research and education of doctors).

Colorectal cancer Laparoscopic or Open Resection II (COLOR II) study group

André d’Hoore, Universitair Ziekenhuis Leuven, Belgium; Dan Birch, Chris DeGara, Royal Alexandra Hospital, Canada; Chris Jamieson, Dalhousie University, Canada; Poornoroozy Peiman, Karl Juul Jensen, SVS Esbjerg, Denmark; Orhan Bulut, Per Jess, Hillerod Hospital, Denmark; Jacob Rosenberg, Herlev Hospital, Denmark; Thomas Harvald, Gentofte Amtssygehus, Denmark; Henrik Ovesen, Roskilde Sygehus, Denmark; Eskilde Lundhus, Regionshospitalet Viborg, Denmark; Igors Iesalnieks, Ayman Agha, University Hospital Regensburg, Germany; Christina Jaeger, Marienhospital, Germany; Martin Kreis, Michael Kasparek, Ludwig Maximillians Universtitat klinikum Groβhadern, Germany; Alois Fürst, Gudrun Liebig-Hoerl, Caritas Krankenhaus St Josef Regensburg, Germany; Seon Hahn Kim, Korea University Anam Hospital, Korea; Jaap Bonjer, Donald van der Peet, Miguel Cuesta, Martijn van der Pas, Mark Buunen, Gabor Abis, Charlotte Deijen, Elly de Lange-de Klerk, VU University Medical Center, The Netherlands; Wim Hop, Erasmus Medical Center, The Netherlands; Peter Neijenhuis, Rijnland Ziekenhuis, The Netherlands; Peter Paul Coene, Edwin van der Harst, Maasstad Ziekenhuis, The Netherlands; Yvonne van ‘t Riet, Catharina Ziekenhuis Eindhoven, The Netherlands; Willem Bemelman, Academisch Medisch Centrum, The Netherlands; Michael Gerhards, Onze Lieve Vrouwe Gasthuis, The Netherlands; Hubert Prins, Jeroen Bosch Ziekenhuis Hertogenbosch, The Netherlands; Eduardo Targarona, Carmen Balague, Carmen Martinez, Hospital de Sant Pau, Spain; Juan Franco Osorio, Garcia Molina, Hospital SAS de Jerez, Spain; Antonio Lacy, Salvadora Delgado, Hospital clinic I Provincial de Barcelona, Spain; Juan Lujan, Graciela Valero, Arrixaca Hospital Universitario, Spain; Alfredo Alonso-Poza, Manual Losadar, Salvador Argudo, Hospital del Sureste de Madrid, Spain; Zoltan Lackberg, Uddevalla Hospital, Sweden; Stefan Skullman, Karnsjukhuset-Skovde Hospital, Sweden; Goran Kurlberg, Eva Haglind, John Andersson, Eva Angenete, Jan Ekelund, Sahlgrenska Universitetssjukhuset Goteborg, Sweden; Ulf Kressner, Danderyd Hospital, Sweden; Peter Matthiessen, Orebro University, Sweden.

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Authors and Affiliations

  1. VU University Medical Center, Amsterdam, The Netherlands

    Martijn H. G. M. van der Pas, Charlotte L. Deijen, Gabor S. A. Abis, Elly S. M. de Lange-de Klerk, Miguel A. Cuesta & Hendrik J. Bonjer

  2. Sahlgrenska Universitetssjukhuset Goteborg, Goteborg, Sweden

    Eva Haglind

  3. Caritas Krankenhaus St Josef Regensburg, Regensburg, Germany

    Alois Fürst

  4. Hospital Clinic I Provincial de Barcelona, Barcelona, Spain

    Antonio M. Lacy

Authors
  1. Martijn H. G. M. van der Pas
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  2. Charlotte L. Deijen
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  3. Gabor S. A. Abis
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  4. Elly S. M. de Lange-de Klerk
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  5. Eva Haglind
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  6. Alois Fürst
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  7. Antonio M. Lacy
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  8. Miguel A. Cuesta
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  9. Hendrik J. Bonjer
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Consortia

For the COLOR II study group

  • André d’Hoore
  • , Dan Birch
  • , Chris DeGara
  • , Chris Jamieson
  • , Poornoroozy Peiman
  • , Karl Juul Jensen
  • , Orhan Bulut
  • , Per Jess
  • , Jacob Rosenberg
  • , Thomas Harvald
  • , Henrik Ovesen
  • , Igors Iesalnieks
  • , Ayman Agha
  • , Christina Jaeger
  • , Martin Kreis
  • , Michael Kasparek
  • , Alois Fürst
  • , Gudrun Liebig-Hoerl
  • , Seon Hahn Kim
  • , Jaap Bonjer
  • , Donald van der Peet
  • , Miguel Cuesta
  • , Martijn van der Pas
  • , Mark Buunen
  • , Gabor Abis
  • , Charlotte Deijen
  • , Elly de Lange-de Klerk
  • , Wim Hop
  • , Peter Neijenhuis
  • , Peter Paul Coene
  • , Edwin van der Harst
  • , Yvonne van ‘t Riet
  • , Willem Bemelman
  • , Michael Gerhards
  • , Hubert Prins
  • , Eduardo Targarona
  • , Carmen Balague
  • , Carmen Martinez
  • , Juan Franco Osorio
  • , Garcia Molina
  • , Antonio Lacy
  • , Salvadora Delgado
  • , Juan Lujan
  • , Graciela Valero
  • , Alfredo Alonso-Poza
  • , Manual Losadar
  • , Salvador Argudo
  • , Zoltan Lackberg
  • , Stefan Skullman
  • , Goran Kurlberg
  • , Eva Haglind
  • , John Andersson
  • , Eva Angenete
  • , Jan Ekelund
  • , Ulf Kressner
  •  & Peter Matthiessen

Corresponding author

Correspondence to Martijn H. G. M. van der Pas.

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Disclosures

“André d’Hoore, Dan Birch, Chris DeGara, Chris Jamieson, Poornoroozy Peiman, Karl Juul Jensen, Orhan Bulut, Per Jess, Jacob Rosenberg, Thomas Harvald, Henrik Ovesen, Igors Iesalnieks, Ayman Agha, Christina Jaeger, Martin Kreis, Michael Kasparek, Alois Fürst, Gudrun Liebig-Hoerl, Seon Hahn Kim, Jaap Bonjer, Donald van der Peet, Miguel Cuesta, Martijn van der Pas, Mark Buunen, Gabor Abis, Charlotte Deijen, Elly de Lange-de Klerk, Wim Hop, Peter Neijenhuis, Peter Paul Coene, Edwin van der Harst, Yvonne van ‘t Riet, Willem Bemelman, Michael Gerhards, Hubert Prins, Eduardo Targarona, Carmen Balague, Carmen Martinez, Juan Franco Osorio, Garcia Molina, Antonio Lacy, Salvadora Delgado, Juan Lujan, Graciela Valero, Alfredo Alonso-Poza, Manual Losadar, Salvador Argudo, Zoltan Lackberg, Stefan Skullman, Goran Kurlberg, Eva Haglind, John Andersson, Eva Angenete, Jan Ekelund, Ulf Kressner and Peter Matthiessen have no conflicts of interest or financial ties to disclose.”

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van der Pas, M.H.G.M., Deijen, C.L., Abis, G.S.A. et al. Conversions in laparoscopic surgery for rectal cancer. Surg Endosc 31, 2263–2270 (2017). https://doi.org/10.1007/s00464-016-5228-8

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