title: Laparoscopic rectal resection for cancer: effects of conversion on short-term outcome and survival.
abstract: BACKGROUND
  Laparoscopic rectal resection (LRR) is an oncologically safe procedure. The impact of conversion to open surgery on outcomes has not been fully elucidated. The aim of the study is to compare short- and long-term outcomes of converted (CR) and not converted (NCR) patients undergoing LRR.
  
  
  METHODS
  Data were drawn from a prospective database of LRR performed between 1999 and 2008. Statistical analysis employed the chi-squared or Wilcoxon test and Kaplan-Meier estimation.
  
  
  RESULTS
  Of 173 patients undergoing LRR, 26 (15%) required conversion. No differences in age, gender, American Society of Anesthesiologists (ASA) score, and T and N stages were observed between CR and NCR patients. Conversion was associated with higher body mass index (BMI) (27.3 versus 24.9 kg/m(2), P < 0.001) and American Joint Committee on Cancer (AJCC) stage IV (26.9% versus 4.8%, P < 0.001), and resulted in longer operative time (342 versus 285 min, P = 0.006) and increased intraoperative complication rate (31% versus 5%, P < 0.001). No differences were observed in postoperative outcome between CR and NCR patients. After a mean follow-up of 46 and 36 months, 5-year disease-free survival was 55.7% in CR group and 79.2% in NCR group (P = 0.007). After exclusion of stage IV patients from the analysis, 5-year disease-free survival was 71.1% in CR group and 85.3% in NCR group (P = 0.17), while the overall recurrence rate was 26.3% in CR patients and 11.4% in NCR patients (P = 0.07).
  
  
  CONCLUSIONS
  Our study suggests that conversion to open surgery does not affect postoperative outcome, but could have a negative impact on long-term overall recurrence rate. LRR should be performed by experienced surgeons in selected patients.
authors.affiliation: General Surgery III, University of Milan, Istituto Clinico Humanitas IRCCS, Rozzano, Milan, Italy. matteo.rottoli@gmail.com
authors.forename: Matteo
authors.initials: M
authors.lastname: Rottoli
authors.forename: Stefano
authors.initials: S
authors.lastname: Bona
authors.forename: Riccardo
authors.initials: R
authors.lastname: Rosati
authors.forename: Ugo
authors.initials: U
authors.lastname: Elmore
authors.forename: Paolo P
authors.initials: PP
authors.lastname: Bianchi
authors.forename: Antonino
authors.initials: A
authors.lastname: Spinelli
authors.forename: Cristina
authors.initials: C
authors.lastname: Bartolucci
authors.forename: Marco
authors.initials: M
authors.lastname: Montorsi
mesh_terms: D000368:Aged; D003082:Colectomy / Q000379:methods / Q000401:mortality*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012004:Rectal Neoplasms / Q000601:surgery* / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome