Predictors of conversion in laparoscopic-assisted colectomy for colorectal cancer and clinical outcomes.
This study investigated risk factors and impact of open conversion on outcomes of 207 consecutive patients who had laparoscopic resection of colorectal cancer at our institution. Conversion occurred in 15.9% of patients, mostly because of invasion to adjacent structures (30.3%), bulky tumor (21.2%), and adhesions (18.2%). Converted patients had significant larger tumor size, advanced stage, increased operative blood loss, time to walk independently, prolonged hospital stay, number of massive hemorrhage, ileus, anastomotic hemorrhage, abdominal hemorrhage, peritonitis/septic shock, and wound infection than completed laparoscopy patients. Factors associated with conversion were obesity [relative risk (RR)=6.92; 95% confidence interval (CI), 1.7-28.09], date of operation (RR=0.37; 95% CI, 0.15-0.95), advanced tumor stage (RR=7.67; 95% CI; 1.19-49.2), size (RR=1.97; 95% CI, 1.42-2.72), and rectum location (RR=2.73; 95% CI, 1.09-6.84). Converted patients had worse cumulative disease-free (P<0.001) and overall survival (P<0.001) than laparoscopic completed patients.
*Department of General Surgery, Section of General Surgery and Oncology, School of Medicine †Department "G. F. Ingrassia," Section of Hygiene and Public Health, University of Catania, Catania ‡Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center, Palermo, Italy.
Antonio
A
Biondi
Giuseppe
G
Grosso
Antonio
A
Mistretta
Stefano
S
Marventano
Alessandro
A
Tropea
Salvatore
S
Gruttadauria
Francesco
F
Basile
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D061887:Conversion to Open Surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D007813:Laparotomy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome