title: Cancer recurrence following conversion during laparoscopic colorectal resections: a meta-analysis.
abstract: BACKGROUND
  Evidence regarding long-term oncological outcomes following conversion to open surgery (COS) during laparoscopic colorectal resection (LCR) is controversial. The aim of this study is to assess the impact on cancer recurrence of a failed laparoscopic attempt.
  
  
  METHODS
  MEDLINE, Scopus and ISI Web of Knowledge databases were searched for articles reporting data on cancer recurrence in patients undergoing completed LCR and COS. Data were pooled by fixed or random effect modeling, according to the presence of heterogeneity. Primary outcomes were local recurrence (LR) and distance recurrence (DR).
  
  
  RESULTS
  Seven studies involving 2493 patients (completed LCR, n 2201 and COS, n 292) were included. The pooled analysis showed that COS resections have an higher risk of LR (OR 1.97, 95% CI 1.14-3.42, p = 0.1); no difference was found in DR (OR 1.09, 95% CI 0.67-1.77, p = 0.71). However, an higher rate of T4 tumor was present in the converted group (OR 2.62, 95% CI 1.71-4, p = 0.0). Subgroup analysis including studies with T stage matched populations showed no significant statistical difference in LR rate; however, a trend toward higher recurrence was still clear.
  
  
  CONCLUSIONS
  There is no consistent evidence that a failed laparoscopic attempt does not result in a poorer oncological outcome; therefore, a careful selection of patients for LCR for cancer is required.
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy. mariano.giglio@hotmail.it.
authors.forename: Mariano Cesare
authors.identifier: http://orcid.org/0000-0002-9222-5885
authors.initials: MC
authors.lastname: Giglio
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Luglio
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy.
authors.forename: Viviana
authors.initials: V
authors.lastname: Sollazzo
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy.
authors.forename: Filomena
authors.initials: F
authors.lastname: Liccardo
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Peltrini
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Sacco
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Spiezio
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Amato
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy.
authors.forename: Giovanni Domenico
authors.initials: GD
authors.lastname: De Palma
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Bucci
mesh_terms: D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery; D006801:Humans; D007432:Intraoperative Period; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000517:prevention & control; D010043:Outcome and Process Assessment, Health Care
keywords: Cancer recurrence; Colorectal resection; Conversion to open surgery; Meta-analysis