Converted laparoscopic colorectal surgery.
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.
Gervaz
P
P
Department of Colon and Rectal Surgery, Cleveland Clinic Florida, 3000 West Cypress Creek Road, Fort Lauderdale, FL 33309, USA.
Pikarsky
A
A
Utech
M
M
Secic
M
M
Efron
J
J
Belin
B
B
Jain
A
A
Wexner
S
S
D000368:Aged; D003082:Colectomy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000601:surgery*; D004239:Diverticulitis, Colonic / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data*; D007902:Length of Stay; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome