title: The impact of laparoscopic converted to open colectomy on short-term and oncologic outcomes for colon cancer.
abstract: OBJECTIVE
  This study was designed to evaluate the impact of laparoscopic converted to open colectomy on short-term and oncologic outcomes and to identify risk factors for long-term survival in patients undergoing colectomy for non-metastatic colon cancer.
  
  
  METHODS
  A prospective database of consecutive operations for non-metastatic colon cancer was reviewed. Patients were grouped as conversion (CONV) group, completed laparoscopic resection (LAP) group, or open resection (OPEN) group. The clinical and perioperative parameters, pathologic features, and oncologic outcomes were collected. Univariate analysis was performed for comparing these data. Patients without evidence of recurrence at last follow-up or still alive at the end of study period were censored. Kaplan-Meier curves were utilized to analyze survival. A multivariate analysis was performed to identify predictors of poor disease-free survival (DFS) and overall survival (OS).
  
  
  RESULTS
  The conversion rate was 15.2 %. The most common reason for conversion was locally advanced cancer (45.5 %). Converted patients were associated with a longer operative time (188 ± 29.1 min, P < 0.001), greater blood loss (147 ± 14 mL, P < 0.001), and a higher rate of intra-operative complications (15.2 %, P = 0.042) compared to the completely laparoscopic or open patients. Days to flatus, early ambulation, and length of hospitalization were significantly shorter in completed laparoscopic resection (LAP) group (P < 0.001); however, the outcomes were comparable between conversion (CONV) and open resection (OPEN) groups. The incidence of wound infection was significantly higher in the OPEN group than in the LAP group (P = 0.005), whereas there were no significant differences observed between the CONV group and the OPEN group (P = 1.000) or between the LAP group and the CONV group (P = 0.073). The 5-year DFS in CONV patients (46.5 %) was comparable to LAP patients (55.5 %, P = 0.138) and OPEN patients (59.1 %, P = 0.113). Moreover, there were no significant differences noted in terms of the 5-year OS in the CONV group (56.7 %) compared to the LAP group (67.3 %, P = 0.317) or the OPEN group (66.3 %, P = 0.420). The multivariate analysis showed that pT3-4 cancer (P < 0.001) and poor differentiation (P < 0.001) were independent predictors of both lower OS and lower DFS, whereas leakage (P = 0.008) and lack of adjuvant chemotherapy (P = 0.023) were independent risk factors only of lower DFS.
  
  
  CONCLUSIONS
  Conversion to open colectomy from an initial laparoscopic approach does not worsen the long-term survival in patients with non-metastatic colon cancer.
authors.affiliation: Department of General Surgery, 5th Affiliated Hospital, Sun Yat-Sen University, No. 52 Meihua East Road, Zhuhai, 519000, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Li
authors.forename: Hui
authors.initials: H
authors.lastname: Guo
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Guan
authors.forename: Chao-Nong
authors.initials: CN
authors.lastname: Cai
authors.forename: Lu-Kun
authors.initials: LK
authors.lastname: Yang
authors.forename: Yue-Chan
authors.initials: YC
authors.lastname: Li
authors.forename: Yan-Hua
authors.initials: YH
authors.lastname: Zhu
authors.forename: Pei-Ping
authors.initials: PP
authors.lastname: Li
authors.forename: Xia-Lei
authors.initials: XL
authors.lastname: Liu
authors.forename: Dong-Jie
authors.initials: DJ
authors.lastname: Yang
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D017024:Chemotherapy, Adjuvant; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D003110:Colonic Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D061887:Conversion to Open Surgery / Q000009:adverse effects; D018572:Disease-Free Survival; D004434:Early Ambulation; D005260:Female; D041981:Gastrointestinal Tract / Q000502:physiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D061646:Operative Time; D019106:Postoperative Hemorrhage; D020127:Recovery of Function; D013530:Surgical Wound Infection / Q000209:etiology; D015996:Survival Rate; D016896:Treatment Outcome