Skip to main content

Advertisement

SpringerLink
Log in

The point of conversion in laparoscopic colonic surgery affects the oncologic outcome in an experimental rat model

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Approximately 20% of laparoscopic colonic tumor resections result in conversion to open surgery. This result may be related to an increased risk in terms of the oncologic outcome. This study aimed to investigate the oncologic consequences of early and late conversion in laparoscopic colonic surgery.

Methods

For this study, 45 male WAG-Rij rats were randomized into three operation groups of 15 animals each: laparotomy (LT group), laparoscopy followed by early conversion after 20 min (EC group), and laparoscopy followed by late conversion after 40 min (LC group). The total procedure time for the LT and EC groups was 60 min, compared with 80 min for the LC group. Hematogenous metastatic spread was induced in each operation group by tumor cell inoculation of a rat colon adenocarcinoma (CC 531) into the portal vein after 15 min of surgical intervention. A cecal resection was performed after 30 min in the LT and EC groups and after 50 min in the LC group. On day 28 after surgery, hepatic tumor growth was evaluated by measuring the diameter of tumor nodules, the tumor volume, the weight of the liver, and the cancer index.

Results

Hepatic tumor volume was significantly increased after LC than after EC (p = 0.01) and LT (p = 0.04). The liver weights in the LC group were significantly higher than in the EC (p = 0.01) and LT (p = 0.01) groups. No significant difference between EC and LT was observed in any parameters surveyed.

Conclusion

The LC procedure resulted in greater tumor growth than EC and LT. The EC procedure did not lead to significantly more hepatic tumor growth than the same procedure performed using the conventional open technique. From the oncologic point of view, an early decision for conversion must be recommended as soon as any prolonged operating time has to be hypothesized.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Nelson H, Sargent DJ, Wieand HS, Fleshman J, Anvari M, Stryker SJ, Beart RW, Hellinger M, Flanagan R, Peters W, Ota D (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer: the clinical outcomes of surgical therapy study group. N Engl J Med 350:2050–2059

    Article  CAS  Google Scholar 

  2. Curet MJ, Putrakul K, Pitcher DE, Josloff RK, Zucker KA (2000) Laparoscopically assisted colon resection for colon carcinoma: perioperative results and long-term outcome. Surg Endosc 11:1062–1066

    Article  Google Scholar 

  3. Lujan HJ, Plasencia G, Jacobs M, Viamonte M III, Hartmann RF (2002) Long-term survival after laparoscopic colon resection for cancer: complete five-year follow-up. Dis Colon Rectum 4:491–501

    Article  Google Scholar 

  4. Patankar SK, Larach SW, Ferrara A, Williamson PR, Gallagher JT, DeJesus S, Narayanan S (2003) Prospective comparison of laparoscopic vs open resections for colorectal adenocarcinoma over a ten-year period. Dis Colon Rectum 5:601–611

    Article  Google Scholar 

  5. Capussotti L, Massucco P, Muratore A, Amisano M, Bima C, Zorzi D (2004) Laparoscopy as a prognostic factor in curative resection for node positive colorectal cancer: results for a single-institution nonrandomized prospective trial. Surg Endosc 7:1130–1135

    Google Scholar 

  6. Kaiser AM, Kang JC, Chan LS, Vukasin P, Beart RW Jr (2004) Laparoscopic-assisted vs open colectomy for colon cancer: a prospective randomized trial. J Laparoendosc Adv Surg Tech A 6:329–334

    Google Scholar 

  7. Jacob BP, Salky B (2005) Laparoscopic colectomy for colon adenocarcinoma: an 11-year retrospective review with 5-year survival rates. Surg Endosc 5:643–649

    Article  Google Scholar 

  8. Mehta PP, Griffin J, Ganta S, Rangraj M, Steichen F (2005) Laparoscopic-assisted colon resections: long-term results and survival. JSLS 2:184–188

    Google Scholar 

  9. Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G (2002) Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 3:321–328

    Article  Google Scholar 

  10. Schwenk W, Haase O, Neudecker J, Muller JM (2005) Short-term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 3:CD003145

    PubMed  Google Scholar 

  11. Gervaz P, Pikarsky A, Utech M, Secic M, Efron J, Belin B, Jain A, Wexner S (2001) Converted laparoscopic colorectal surgery. Surg Endosc 8:827–832

    Article  Google Scholar 

  12. Schlachta CM, Mamazza J, Seshadri PA, Cadeddu M, Gregoire R, Poulin EC (2001) Defining a learning curve for laparoscopic colorectal resections. Dis Colon Rectum 2:217–222

    Article  Google Scholar 

  13. Slim K, Pezet D, Riff Y, Clark E, Chipponi J (1995) High morbidity rate after converted laparoscopic colorectal surgery. Br J Surg 10:1406–1408

    Article  Google Scholar 

  14. Schlachta CM, Mamazza J, Seshadri PA, Cadeddu M, Poulin EC (2000) Determinants of outcomes in laparoscopic colorectal surgery: a multiple regression analysis of 416 resections. Surg Endosc 3:258–263

    Article  Google Scholar 

  15. Maloo H, Mamazza J, Poulin EC, Burpee SE, Bendavid Y, Klein L, Gregoire R, Schlachta CM (2004) Laparoscopic resections for colorectal cancer: does conversion survival? Surg Endosc 5:732–735

    Google Scholar 

  16. Bingener-Casey J, Richards ML, Strodel WE, Schwesinger WH, Sirinek KR (2002) Reasons for conversion from laparoscopic to open cholecystectomy: a 10-year review. J Gastrointest Surg 6:800–805

    Article  PubMed  Google Scholar 

  17. Khaitan L, Apelgren K, Hunter J, Traverso LW (2003) A report on the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) Outcomes Initiative: what have we learned and what is its potential? Surg Endosc 3:365–370

    Article  Google Scholar 

  18. Daradkeh S (2005) Laparoscopic cholecystectomy: analytical study of 1,208 cases. Hepatogastroenterology 64:1011–1014

    Google Scholar 

  19. Hwang H, Turner LJ, Blair NP (2005) Examining the learning curve of laparoscopic fundoplications at an urban community hospital. Am J Surg 5:522–526

    Article  Google Scholar 

  20. Marquet RL, Westbroek DL, Jeekel J (1984) Interferon treatment of a transplantable rat colon adenocarcinoma: importance of tumor site. Int J Cancer 5:689–692

    Article  Google Scholar 

  21. Nieuwoudt MJ, Kreft E, Olivier B, Malfeld S, Vosloo J, Stegman F, Kunneke R, Van Wyk AJ, Van der Merwe SW (2005) A large-scale automated method for hepatocyte isolation: effects on proliferation in culture. Cell Transplant 5:291–299

    Article  Google Scholar 

  22. Weiskirchen R, Gressner AM (2005) Isolation and culture of hepatic stellate cells. Methods Mol Med 117:99–113

    PubMed  CAS  Google Scholar 

  23. Gutt CN, Riemer V, Brier C, Berguer R, Paolucci V (1998) Standardized technique of laparoscopic surgery in the rat. Dig Surg 2:135–139

    Article  Google Scholar 

  24. Gutt CN, Kim ZG, Gessmann T, Lorenz M, Paolucci V (2000) Hepatic tumor spread of colorectal cancer in a laparoscopic animal model. Surg Endosc 5:448–451

    Article  Google Scholar 

  25. Gutt CN, Riemer V, Kim ZG, Erceg J, Lorenz M (2001) Impact of laparoscopic surgery on experimental hepatic metastases. Br J Surg 3:371–375

    Article  Google Scholar 

  26. Steller EP, Ottow RT, Eggermont AM, Marquet RL, Sugarbaker PH (1988) Local conditions in the host influence immunotherapy with interleukin-2 and LAK cells. Cancer Detect Prev 12:81–90

    PubMed  CAS  Google Scholar 

  27. Bouvy ND, Marquet RL, Jeekel H, Bonjer HJ (1996) Impact of gas(less) laparoscopy and laparotomy on peritoneal tumor growth and abdominal wall metastases. Ann Surg 6:694–700

    Article  Google Scholar 

  28. Schwandner O, Schiedeck TH, Bruch H (1999) The role of conversion in laparoscopic colorectal surgery: do predictive factors exist? Surg Endosc 2:151–156

    Article  Google Scholar 

  29. Hartley JE, Mehigan BJ, Monson JR (2001) Alterations in the immune system and tumor growth in laparoscopy. Surg Endosc 3:305–313

    Article  Google Scholar 

  30. Gutt CN, Gessmann T, Schemmer P, Mehrabi A, Schmandra T, Kim ZG (2003) The impact of carbon dioxide and helium insufflation on experimental liver metastases, macrophages, and cell adhesion molecules. Surg Endosc 10:1628–1631

    Article  Google Scholar 

  31. Gutt CN, Kim ZG, Schmandra T, Paolucci V, Lorenz M (2000) Carbon dioxide pneumoperitoneum is associated with increased liver metastases in a rat model. Surgery 5:566–570

    Article  Google Scholar 

  32. Gutt CN, Oniu T, Mehrabi A, Schemmer P, Kashfi A, Kraus T, Buchler MW (2004) Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg 2:95–105

    Article  Google Scholar 

  33. Glantzounis GK, Tselepis AD, Tambaki AP, Trikalinos TA, Manataki AD, Galaris DA, Tsimoyiannis EC, Kappas AM (2001) Laparoscopic surgery-induced changes in oxidative stress markers in human plasma. Surg Endosc 11:1315–1319

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Martin A. Thome, Beat Müller-Stich, Ulf Hinz, Markus W. Büchler & Carsten N. Gutt

  2. German Cancer Research Centre, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany

    David Ehrlich & Robert Koesters

  3. Department of Plastic and Hand Surgery, University of Erlangen, Krankenhausstraße 12, 91054, Erlangen, Germany

    Frank Unglaub

Authors
  1. Martin A. Thome
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Ehrlich
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert Koesters
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Beat Müller-Stich
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Frank Unglaub
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ulf Hinz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Markus W. Büchler
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Carsten N. Gutt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin A. Thome.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thome, M.A., Ehrlich, D., Koesters, R. et al. The point of conversion in laparoscopic colonic surgery affects the oncologic outcome in an experimental rat model. Surg Endosc 23, 1988–1994 (2009). https://doi.org/10.1007/s00464-008-9971-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-008-9971-3

Keywords

Search

Navigation