Converting Laparoscopic Surgery in Colon Cancer Has No Greater Effect Than Planned Open Surgery
*Lieve GJ Leijssen, *Anne M Dinaux, Hiroko Kunitake, Liliana G Bordeianou, David L Berger
Massachusetts General Hospital / Harvard Medical School, Boston, MA
Objective: Laparoscopic surgery is well established as a safe and technically feasible procedure in the treatment of colon cancer. However, conversion rates remain high and research on the outcomes of conversion is limited. This study aimed to evaluate the impact of conversion to open surgery in patients with colon cancer on short-term outcomes.
Design: Retrospective review of a prospective maintained database.
Setting: Tertiary care center.
Patients: All patients who underwent an elective non-multivisceral resection for colon cancer between 2004-2014. Patients were stratified into three groups: completed laparoscopic surgery (LS), open surgery (OS), and conversion to open surgery (CS).
Interventions:
Main Outcome Measures: 30-day morbidity and mortality.
Results: Of all 1019 patients, 320 patients underwent LS (31.4%), 662 underwent OS (65.0%), and 37 CS 3.6%). The conversion rate was 10.4%. The two most common reasons for conversion were adhesions (29.7%) or tumor size (16.2%). Conversion was associated with male gender and transverse tumors. Converted patients had more stage-III-node positive disease in comparison to both OS and LS (P<0.05). Length of stay, complications during admission, and readmission rate were significantly lower for LS patients compared to both CS and OS (P0.05). Short-term outcomes were comparable between OS and CS.
Conclusions: Short-term outcomes after conversion were significantly worse compared to LS, but were comparable to planned open surgery. This study underlines that conversion can be considered as a simple drawback in the treatment of colon cancer, not as either detrimental or a complication per se.
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