title: Impact of Conversion to Open Surgery on Early Postoperative Morbidity After Laparoscopic Resection for Rectal Adenocarcinoma: A Retrospective Study.
abstract: BACKGROUND
  The impact of conversion to open surgery after a laparoscopic resection for rectal adenocarcinoma on postoperative morbidity is still unclear. Most previous studies included colon and rectal carcinomas and produced conflicting results. The aim of this study was to investigate the impact of conversion to open surgery on early postoperative morbidity in patients who underwent a laparoscopic resection for rectal adenocarcinoma.
  
  
  METHODS
  This was a retrospective bicentric study. It included all consecutive patients who underwent a laparoscopic resection for nonmetastatic rectal adenocarcinoma between January 2005 and December 2013. The impact of conversion to open surgery on 30-day postoperative morbidity was analyzed by univariate and multivariate analyses. Risk factors for conversion were also investigated by univariate and multivariate analyses.
  
  
  RESULTS
  One hundred thirty-one patients were included. The conversion rate was 26.7%. The global 30-day morbidity rate was 31.3% (41 patients). The conversion to open surgery was associated with higher rates of postoperative complications, anastomotic leaks, and reoperations. It was also an independent predictive factor to postoperative morbidity in the multivariate analysis (P = .01; odds ratio 2.86; 95% confidence interval [CI] 1.23-6.63), in addition to T4 tumors (P = .04; odds ratio 3.92; 95% CI 1.05-14.61). Risk factors for conversion in the multivariate analysis were T4 tumors (P = .006; odds ratio 6.09; 95% CI 1.66-22.32) and the height of the tumor (P = .025; odds ratio 2.7; 95% CI 1.13-6.43).
  
  
  CONCLUSIONS
  This study showed that conversion to open surgery after laparoscopic proctectomy for rectal adenocarcinoma was associated with higher rates of early postoperative complications. It also showed that T4 tumors and the height of the tumor were independent factors associated with the conversion to open surgery. Reducing postoperative morbidity could be achieved by a better patient selection and a policy of early conversion.
authors.affiliation: 1 Surgery Department, Faculty of Medicine, Mohammed V University in Rabat , Rabat, Morocco .|2 Surgical Unit C, Ibn Sina University Hospital , Rabat, Morocco .
authors.forename: Anass Mohammed
authors.initials: AM
authors.lastname: Majbar
authors.affiliation: 3 Surgery Unit, Anti Cancer Center , Batna, Algeria .
authors.forename: Mourad
authors.initials: M
authors.lastname: Abid
authors.affiliation: 1 Surgery Department, Faculty of Medicine, Mohammed V University in Rabat , Rabat, Morocco .|2 Surgical Unit C, Ibn Sina University Hospital , Rabat, Morocco .
authors.forename: Mouna
authors.initials: M
authors.lastname: Alaoui
authors.affiliation: 1 Surgery Department, Faculty of Medicine, Mohammed V University in Rabat , Rabat, Morocco .|2 Surgical Unit C, Ibn Sina University Hospital , Rabat, Morocco .
authors.forename: Farid
authors.initials: F
authors.lastname: Sabbah
authors.affiliation: 1 Surgery Department, Faculty of Medicine, Mohammed V University in Rabat , Rabat, Morocco .|2 Surgical Unit C, Ibn Sina University Hospital , Rabat, Morocco .
authors.forename: Mohamed
authors.initials: M
authors.lastname: Raiss
authors.affiliation: 1 Surgery Department, Faculty of Medicine, Mohammed V University in Rabat , Rabat, Morocco .|2 Surgical Unit C, Ibn Sina University Hospital , Rabat, Morocco .
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ahallat
authors.affiliation: 1 Surgery Department, Faculty of Medicine, Mohammed V University in Rabat , Rabat, Morocco .|2 Surgical Unit C, Ibn Sina University Hospital , Rabat, Morocco .
authors.forename: Abdelmalek
authors.initials: A
authors.lastname: Hrora
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology; D061887:Conversion to Open Surgery / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011184:Postoperative Period; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden