Conversion from laparoscopic to open colonic cancer resection - associated factors and their influence on long-term oncological outcome.
OBJECTIVE
Comparisons of open and laparoscopic colon cancer resection have shown that laparoscopy offers an oncologically safe option. However, there are no data on long-term influence of converted resection, despite conversion rates of up to 30% and the general observation that short-term outcome is significantly worsened. The aim was to compare the long-term results of primary open resection (OR), purely laparoscopic resection (LR-p) and converted resection (LR-c).


METHODS
In a prospective study at 282 German hospitals demographic, tumor- and treatment-related data and disease-free survival were compared in the three groups.


RESULTS
8015 of 8307 patients with OR, 280 of 290 patients with LR-p and 55 of 56 patients with LR-c were followed for 39.5 months (median). Overall, no statistically significant differences were seen for five-year DFS (74.8%, 81.3% and 65.6%). However, for patients in stage II with conversion, the five-year DFS was significantly poorer (43.3%) than for OR (80.5%; p=0.003) and LR-p patients (92.5%; p=0.001). For stages I and III no differences were observed.


CONCLUSIONS
Conversion of laparoscopic colon cancer resection worsens DFS in locally advanced stage II carcinoma. There is a need to reduce the conversion rate by adequate patient selection for laparoscopic resection by experienced surgeons.
Ptok
H
H
Institute of Quality Control in Operative Medicine, University Hospital of Otto von Guericke, University of Magdeburg, Leipziger Strasse 44, 39120 Magdeburg, Germany. henry.ptok@med.ovgu.de
Kube
R
R
Schmidt
U
U
Köckerling
F
F
Gastinger
I
I
Lippert
H
H
D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005858:Germany; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009367:Neoplasm Staging; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome