Conversion in laparoscopic surgery: does intraoperative complication influence outcome?

Abstract

Preemptive conversion is associated with a better outcome than reactive conversion. Based on this finding, it appears preferable for the surgeon to have a low threshold for performing PC rather than awaiting the need for an RC.

Conversion in Laparoscopic Colorectal Cancer Surgery: Impact on Short- and Long-Term Outcome

“…This concords to a large extent with a number of studies in which intraoperative complications occurred in only between 5% and 16% of cases, whereas conversion because of adhesions or for tumor-related reasons ranging from 40% to 66% was markedly more common. 1,[11][12][13][14][15]19,20 However, this appears to suggest that, in principle, a decision in favor of conversion can be taken in the majority of cases at an early, and, thus, relatively favorable, time point. 11 The conversion rates given in the literature for colorectal surgery are between 2% and 35%; 7,16,22 hence, our conversion rate of 5.7% for the comparatively large patient collective tends to be at the lower end.…”

“…Conversion is viewed in a critical light in terms of prognosis, in particular when evaluating curative resection of colorectal carcinomas, 12,13 despite it not being deemed per se to be a complication. 7 However, in the current literature, there are divergent views of the role of conversion, 7,9,10 with some authors stating that converted patients face no disadvantages, 3,6,8,11,[14][15][16][17] whereas other groups of authors believe that there are potential drawbacks in terms of morbidity and mortality 2,7,10,11,18,19 or long-term outcome. 3,12,13,20 The conversion rate of the 5.7% identified here is somewhat at the lower end of the range of 1.9% to 25% given in the literature for larger patient collectives 6,7,12,13,16,19,21 and is not higher than in the case of patients undergoing colorectal resection for a benign indication.…”

“…Increased wound problems should also be viewed in the same light, which is understandable due to the much larger wound surface and that also has been reported in almost all other studies. 2,7,10,11,19,20 Evaluation of long-term outcome revealed a significantly poorer overall survival with identical disease-free survival (Figs. 1, 2, and 3).…”

“…5,6 One of the primary issues frequently disputed here is the role of conversion, and this discussion continues. [7][8][9][10][11] There is uncertainty about the impact of conversion after laparoscopic resection on short-term outcome, and even more so on longterm outcome after curative resection of carcinomas.…”

Intraoperative events and their outcome: Data from 4007 laparoscopic interventions by the French “Club Cœlio”

“…small bowel or aortic injury); • ''c'' to designate any conversion, whether pre-emptive (before any complication occurs) or reactive (after the complication occurs) [13]; • ''0'' in the complementary information rubric, landmarking those patients in whom no intraoperative event, no conversion, no reoperation, no postoperative surgical or medical complication was noted.…”