Patient factors influencing conversion from laparoscopically assisted to open surgery for colorectal cancer.
BACKGROUND
Intraoperative conversion from laparoscopically assisted to open surgery for colorectal cancer is thought to be influenced by several patient factors. Analysis of the Conventional versus Laparoscopic-Assisted Surgery In Colorectal Cancer (CLASICC) Trial data aimed to identify these risk factors.


METHODS
Of 488 laparoscopically assisted procedures attempted, 143 (29.3 per cent) were converted to open operation. Patient factors considered in multivariable analyses were age, sex, previous abdominal incisions, body mass index (BMI), tumour site, tumour diameter, pathological tumour (pT) and pathological node (pN) stage, extent of tumour spread from the muscularis propria, liver and peritoneal metastases, and American Society of Anesthesiologists (ASA) grade. As BMI was missing for 30.7 per cent of patients, two approaches were employed: one considered BMI as a possible risk factor and one did not.


RESULTS
When BMI was taken into consideration, male sex (odds ratio (OR) 2.07; P = 0.020), BMI (OR 1.10; P = 0.006) and extent of tumour spread from the muscularis propria (OR 1.08; P < 0.001) were independent predictors of conversion. When BMI was not considered, extent of tumour spread (OR 1.07; P < 0.001) and male sex (OR 2.05; P = 0.004) were again identified, as were tumour site (OR 2.11; P = 0.005) and ASA grade (II versus I, OR 0.92; III versus I, OR 2.74; P = 0.012).


CONCLUSIONS
Intraoperative conversion is more likely with larger BMI, in men, patients with rectal cancer, those graded ASA III or when there is greater local tumour spread.
Thorpe
H
H
Clinical Trials Research Unit, Leeds Institute of Molecular Medicine, University of Leeds, Leeds UK. h.c.thorpe@leeds.ac.uk
Jayne
D G
DG
Guillou
P J
PJ
Quirke
P
P
Copeland
J
J
Brown
J M
JM
D000368:Aged; D015992:Body Mass Index; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D018579:Patient Selection; D012004:Rectal Neoplasms / Q000601:surgery*; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome