Impact of conversion on the outcome and survival following laparoscopic resection of colorectal cancer

Abstract

Background: Conversion to open surgery occurred in 12-29% of the patients who underwent laparoscopic colorectal resection. This study aimed to evaluate the impact of conversion on the operative outcome and prognosis of patients who underwent laparoscopic resection for colorectal cancer. Methods: The prospectively collected data of 473 patients who underwent laparoscopic colectomy between May 2000 and December 2006 were analyzed. Patient demographics, operative details, postoperative complications and follow up data were collected prospectively. Conversion was defined as the need for an unplanned incision to complete the attempted laparoscopic procedure due to patients’ factors, tumor factors as well as intraoperative complications. Results: The overall conversion rate to open surgery was 8.7% (41 patients). There was no difference in age, comorbid illness, location of tumour, use of adjuvant therapy and stage of disease between the laparoscopic and conversion group. The most common reasons for conversion include adhesions (34.1%), tumour invasion into adjacent structures (17.1%), bulky tumour (9.8%), and uncontrolled haemorrhage (9.8%). A male preponderance was observed in the conversion group. Tumour size was significantly larger in the conversion group compared with the laparoscopic group (5cm vs. 4cm, p=0.002). Although there was no difference in the operative time between the two groups, increased operative blood loss (300ml vs. 100ml ......