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Converted laparoscopic colorectal surgery

A meta-analysis

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Abstract

Background

Conversion rates following laparoscopic colorectal surgery vary widely between studies, and the outcome of converted patients remains controversial.

Methods

A comprehensive search of the English-language literature was updated until May 1999.

Results

Twenty-eight studies on 3232 patients were considered for analysis. The overall conversion rate was 15.38%. Seventy nine percent of the studies did not include a definition for conversion; in these studies, the conversion rate was significantly lower than in the series where a specific definition was considered (13.7% vs 18.9%, chi-square test, p<0.001). Converted patients had a prolonged hospital stay (11.38 vs 7.41 days) and operative time (209 vs 189 min) in comparison with laparoscopically completed patients (95% confidence interval (CI), 1.70–4.00 and 35.90–37.10, respectively). The factors associated with an increased rate for conversion were left colectomy (Odds Ratio [OR]=1.061), anterior resection of the rectum (OR=1.088), diverticulitis (OR=1.302), and cancer (OR=2.944) (for each parameter, Wald chi-square value, p<0.001).

Conclusions

In nonrandomized studies, the rate of laparoscopically completed colorectal resections is close to 85%. Because converted patients have a distinct outcome, a clear definition of conversion is required to compare the results of randomized trials. Such trials should also consider a 20% rate of conversion when estimating the sample size for the desired power level. It is likely that converted patients will have a significant impact on the results of future clinical research in laparoscopic colorectal surgery.

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Authors and Affiliations

  1. Department of Colon and Rectal Surgery, Cleveland Clinic Florida, 3000 West Cypress Creek Road, 33309, Fort Lauderdale, FL, USA

    P. Gervaz, A. Pikarsky, M. Utech, J. Efron, B. Belin, A. Jain & S. Wexner

  2. Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, USA

    M. Secic

Authors
  1. P. Gervaz
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  2. A. Pikarsky
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  3. M. Utech
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  4. M. Secic
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  5. J. Efron
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  6. B. Belin
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  7. A. Jain
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  8. S. Wexner
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Additional information

Online publication: 11 May 2001

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Gervaz, P., Pikarsky, A., Utech, M. et al. Converted laparoscopic colorectal surgery. Surg Endosc 15, 827–832 (2001). https://doi.org/10.1007/s004640080062

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  • DOI: https://doi.org/10.1007/s004640080062

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