title: Conversion during laparoscopic colorectal resections: a complication or a drawback? A systematic review and meta-analysis of short-term outcomes.
abstract: OBJECTIVE
  Several studies compared the outcomes of laparoscopically completed colorectal resections (LCR) to those requiring conversion to open surgery (COS). However, a comparative analysis between COS patients and patients undergoing planned open surgery (POS) would be useful to clarify if the conversion can be considered a simple drawback or a complication, being cause of additional postoperative morbidity. The aim of this study is to perform a meta-analysis of current evidences comparing postoperative outcomes of COS patients to POS patients.
  
  
  METHODS
  A systematic search of Medline, ISI Web of Knowledge, and Scopus was performed to identify studies reporting short-term outcomes of COS and POS patients. Primary outcomes were 30-day overall morbidity and length of postoperative hospital stay. Data were analyzed with fixed-effect modeling, and sensitivity analyses were performed to test the robustness of the results.
  
  
  RESULTS
  Twenty studies involving 30,656 patients undergoing POS and 1935 COS patients were selected. The mean conversion rate was 0.17. Similar 30-day overall morbidity and length of postoperative hospital stay were found in COS and POS patients. Wound infection (OR 1.43, 95 % CI 1.12 to 1.83, p < 0.01) was higher in the COS group. Other results were robust. Outcomes were comparable for patients undergoing resection for different natures of the disease (benign vs. malignant) and at different sites (colon vs. rectum).
  
  
  CONCLUSIONS
  Conversions from laparoscopic to open procedure during colorectal resection are not associated with a poorer postoperative outcome compared to patients undergoing planned open surgery, except for a higher risk of wound infection.
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy. mariano.giglio@hotmail.it.
authors.forename: Mariano Cesare
authors.initials: MC
authors.lastname: Giglio
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Celentano
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
authors.forename: Rachele
authors.initials: R
authors.lastname: Tarquini
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Luglio
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
authors.forename: Giovanni Domenico
authors.initials: GD
authors.lastname: De Palma
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Bucci
mesh_terms: D003106:Colon / Q000601:surgery*; D003108:Colonic Diseases / Q000601:surgery; D061887:Conversion to Open Surgery; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D012002:Rectal Diseases / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome
keywords: Conversion to open surgery; Laparoscopic colorectal resection; Meta-analysis; Short-term outcomes