Converting Laparoscopic Surgery in Colon Cancer: No Greater Effect Than a Planned Open Approach.
Lieve G.J. Leijssen, Anne M. Dinaux, Hiroko Kunitake, Liliana G. Bordeianou, David L. Berger
Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
Background: Although laparoscopic surgery is well established in the treatment of colon cancer, conversion rates remain high. This study aimed to evaluate the impact of conversion to open surgery on both short- and long-term outcomes.
Methods: All patients undergoing elective surgery for colon cancer between 2004-2014 at our tertiary center were included and into three groups: completed laparoscopic surgery (LS), planned open surgery (OS), and conversion to open surgery (CS).
Results: Of all 1347 patients, 505 underwent LS (37.5%), 789 OS (68.6%), and 53 CS (3.9%). This corresponded to a conversion rate of 9.5%, with a slight decrease over the study period. Conversion was associated with male gender, left-sided tumors, and stage-III disease. Compared to LS, CS had more metastatic disease, EMVI, and perineural invasion. LS patients had a shorter length of stay, fewer readmissions and less complications. With the exception of more abscesses after CS, short-term outcomes were comparable with OS. Recurrence rates were higher for CS and OS than LS. Kaplan-Meier curves demonstrated worse overall, disease-specific (P0.001), and disease-free survival in CS (P<0.05), with similar outcomes to OS. In multivariate analysis, LS was an independent predictor in overall survival compared to CS (HR 0.50, P0.019) and non-significantly associated with disease-free survival (HR 0.63, P0.202). Long-term outcomes were comparable between CS and OS.
Conclusion: Conversion is associated with adverse short- and long-term outcomes compared to LS. However, outcomes were comparable with OS, with the exception of more abscesses after CS. Therefore, conversion to open surgery could be considered as a simple drawback, not as either detrimental or a complication per se.
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