Laparoscopic colorectal resection for cancer: effects of conversion on long-term oncologic outcomes

Rottoli, Matteo; Stocchi, Luca; Geisler, Dan; Kiran, Ravi P.

doi:10.1007/s00464-011-2137-8

Cited by 38 publications

(45 citation statements)

References 18 publications

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“…However, the interpretation of these results is limited by the small and heterogeneous groups of patients considered because many studies have included benign diseases such as diverticulitis and inflammatory bowel disease besides colorectal cancers. Data restricted to cancer patients are more controversial [3,17,19,20,22]. Whereas some authors [3,17] have observed that patients undergoing conversion had significantly higher rates of blood transfusions, surgical complications including anastomotic leakage, and reintervention than patients who had a completed LCR, others did not find adverse effects of conversion on the early postoperative outcomes for patients with colorectal cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have reported higher morbidity and mortality rates and a longer postoperative hospital stay [3,[13][14][15][16][17][18], whereas others did not find significant differences in comparisons with to non converted patients [12,[19][20][21][22]. The oncologic outcomes for converted patients are poorly investigated, and the data currently available are unclear [10,[12][13][14][15][16][17][18][19][20][21][22][23]. This study aimed to evaluate the impact of conversion to open surgery on short-and long-term outcomes in a large series of patients undergoing laparoscopic resection for nonmetastatic colorectal cancer.…”

Section: Introductionmentioning

confidence: 99%

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Does conversion affect short-term and oncologic outcomes after laparoscopy for colorectal cancer?

et al. 2013

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Background Conversion of laparoscopic colorectal resection (LCR) for cancer has been associated with adverse short-term and oncologic outcomes. However, most studies have had small sample sizes and short follow-up periods. This study aimed to evaluate the impact of conversion to open surgery on early postoperative outcomes and survival among patients undergoing LCR for nonmetastatic colorectal cancer. Methods A prospective database of consecutive LCRs for nonmetastatic colorectal cancer was reviewed. Patients who required conversion (CONV group) were compared with those who had completed laparoscopic resection (LAP group). Only patients with a minimum 5-year follow-up period were included in the oncologic analysis. Kaplan-Meier curves were compared to analyze survival. A multivariate analysis was performed to identify predictors of poor survival. Results The conversion rate was 10.9 %. The most common reason for conversion was a locally advanced tumor (48.4 %). Conversion was associated with a significantly longer operative time and a greater blood loss. No differences were observed in terms of postoperative morbidity, mortality, or hospital stay between the CONV and LAP patients. During a median follow-up period of 120 months (range, 60-180 months), the CONV group had a significantly worse 5-year overall survival (OS) (79.4 vs 87.4 %; p = 0.016) and disease-free survival (DFS) (65.4 vs 79.6 %; p = 0.013). Univariate analysis showed that conversion to open surgery, postoperative complications, anastomotic leakage, pT4 cancer, stage 3 disease, and adjuvant chemotherapy were significant risk factors for OS and DFS. On multivariate analysis, pT4 cancer and a lymph node ratio (LNR) of 0.25 or greater were the only independent predictors of DFS and OS, whereas a LNR of 0.01 to 0.24 showed a trend that did not reach statistical significance. Recent large RCTs [5,6] as well as a systematic review and metaanalysis of the literature [7] have reported similar advantages of laparoscopic rectal resection and total mesorectal excision (TME) compared with open surgery for extraperitoneal rectal cancer. Evidence from the literature also has shown comparable outcomes in terms of oncologic clearance and long-term survival between laparoscopic and open resection for colon [1,[8][9][10] and rectal cancer [10][11][12]. The rates for conversion of laparoscopic colon resection to open surgery reported in the largest multicenter RCTs range from 17 to 25 % [2-4], whereas the conversion rates for laparoscopic rectal resection vary between 0.6 and 32.4 % [7]. With the exception of the conventional versus laparoscopic-associated surgery in colorectal cancer (CLASICC) trial, all RCTs have analyzed converted patients in the laparoscopic group on an "intention-to-treat" basis. A few nonrandomized studies have examined the short-term outcomes for converted cancer patients. Some studies have reported higher morbidity and mortality rates and a longer postoperative hospital stay [3,[13][14][15][16][17][18], whereas others did not find si...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does conversion affect short-term and oncologic outcomes after laparoscopy for colorectal cancer?

et al. 2013

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“…The full text of the remaining 79 articles was examined in more detail. After excluding 59 studies, 20 studies [11,12,15,16,18,[23][24][25][26][27][28][29][30][31][32][33][34][35][36] were included in the meta-analysis (Fig. 1 [11,16,22,26,27].…”

Section: Study Selectionmentioning

confidence: 99%

“…Rottoli et al [29] Laparotomy created for any purpose other than specimen extraction Senagore et al [23] n . d .…”

Section: Study Selectionmentioning

confidence: 99%

Conversion during laparoscopic colorectal resections: a complication or a drawback? A systematic review and meta-analysis of short-term outcomes

Giglio

Celentano

Tarquini

et al. 2015

Int J Colorectal Dis

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“…Einige Studien hierzu zeigen keinen Unterschied im Outcome nach Konversion [17,18]. Im Gegensatz hierzu bestätigen die Daten der 3- und 5-Jahres-Analyse der CLASICC-Studie ein schlechteres Outcome nach Konversion, was sich jedoch statistisch «lediglich» im Gesamtüberleben signifikant unterschiedlich zeigte [9,14].…”

Section: Diskussionunclassified

Minimalinvasive Chirurgie bei Malignomen des Gastrointestinaltrakts: Kolon - Pro-Position

Späth¹,

Müller²,

Nitsche³

et al. 2013

Visc Med

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Hintergrund: Laparoskopische Resektionen von Kolonkarzinomen werden in Deutschland immer häufiger durchgeführt. Dabei müssen sich die minimalinvasiven Verfahren an den onkologischen Ergebnissen der offenen Chirurgie messen, die bisher den Goldstandard darstellen. Die vorliegende Arbeit soll anhand der evidenzbasierten Literatur einen kritischen Überblick über die Kurz- und Langzeitergebnisse der laparoskopischen Kolonchirurgie geben und sie in Bezug zu den Ergebnissen der offenen Chirurgie setzen. Methoden: Die Grundlage dieser Übersichtsarbeit bilden die fünf größten prospektiv randomisierten Studien zum Vergleich laparoskopischer und offener Chirurgie beim Kolonkarzinom (ALCCaS, Barcelona Trial, CLASICC Trial, COLOR Study und COST Study) sowie die bisher größte und aktuellste Metaanalyse. Im Folgenden sollen die erwähnten Studien hinsichtlich der Kurzzeit- und Langzeitergebnisse kritisch zusammengefasst sowie die wichtigsten Endpunkte beleuchtet werden. Ergebnisse: Die laparoskopische Chirurgie des Kolonkarzinoms ist hinsichtlich der onkologischen Langzeitergebnisse der offenen Resektion zumindest gleichwertig. Vorteile bestehen in der frühen postoperativen Phase sowie im perioperativen Outcome. Die höheren direkten Kosten werden durch kürzere Liegezeiten, niedrigere Morbidität und weniger Re-Interventionen bezüglich Adhäsionen und Narbenhernien ausgeglichen. Schlussfolgerungen: Eine kritische und individuelle Indikationsstellung vorausgesetzt, sollte bei entsprechender Expertise und Erfahrung den laparoskopischen Verfahren zur Therapie des Kolonkarzinoms der Vorzug gegeben werden, um den Patienten bei gleichwertigen onkologischen Langzeitergebnissen die Vorteile der minimalinvasiven Chirurgie nicht vorzuenthalten.

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Laparoscopic colorectal resection for cancer: effects of conversion on long-term oncologic outcomes

Abstract: Conversion to open surgery does not affect oncologic outcomes, although CONV patients have increased comorbidity rates affecting long-term mortality.

Cited by 38 publications

References 18 publications

Does conversion affect short-term and oncologic outcomes after laparoscopy for colorectal cancer?

Does conversion affect short-term and oncologic outcomes after laparoscopy for colorectal cancer?

Conversion during laparoscopic colorectal resections: a complication or a drawback? A systematic review and meta-analysis of short-term outcomes

Minimalinvasive Chirurgie bei Malignomen des Gastrointestinaltrakts: Kolon - Pro-Position

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