title: Does Conversion in Laparoscopic Colectomy Portend an Inferior Oncologic Outcome? Results from 104,400 Patients.
abstract: Limited data exist regarding the effect of conversion from laparoscopic to open colectomy on perioperative and oncologic outcomes in colon cancer.
  
  
  
  The National Cancer Data Base was used to identify patients who underwent colectomy for non-metastatic colon cancer (2010-2012). Patients were stratified into three groups: laparoscopic/robotic-assisted colectomy (MIC), converted colectomy (CC), and open colectomy (OC). Multivariable modeling was applied to compare outcomes from CC and MIC to OC while adjusting for patient, clinical, and tumor characteristics.
  
  
  
  Of 104,400 patients, 40,328 (38.6 %) underwent MIC, 57,928 (55.5 %) OC, and 6144 (5.9 %) CC. After adjustment, the rate of positive surgical margins was not significantly different between CC and OC (p = 0.44). However, with adjustment, CC versus OC was associated with shorter hospital length of stay (4 % decrease, 95 % CI 2-5 %, p < 0.0001) and lower odds of 30-day mortality (OR 0.77, 95 % CI 0.64-0.94, p = 0.0112). Adjusted overall survival was similar between CC and OC (p = 0.34).
  
  
  
  Conversion from laparoscopic to open colectomy was not associated with compromised oncologic outcomes, while maintaining improved short-term outcomes despite being attempted in only 45 % of patients. This data suggests that utilization of laparoscopic colectomy should be attempted for patients with colon cancer.
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA. babatunde.yerokun@duke.edu.
authors.forename: Babatunde A
authors.initials: BA
authors.lastname: Yerokun
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Adam
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Zhifei
authors.initials: Z
authors.lastname: Sun
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Jina
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Shanna
authors.initials: S
authors.lastname: Sprinkle
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: John
authors.initials: J
authors.lastname: Migaly
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Mantyh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000401:mortality / Q000601:surgery*; D061887:Conversion to Open Surgery; D005260:Female; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012371:Robotics; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Colectomy; Colon cancer; Minimally invasive surgery