Risk factors for conversion in laparoscopic and robotic rectal cancer surgery

Abstract

Background The aim of this study was to review risk factors for conversion in a cohort of patients with rectal cancer undergoing minimally invasive abdominal surgery. Methods A retrospective analysis was performed of consecutive patients operated on from February 2005 to April 2018. Adult patients undergoing low anterior resection or abdominoperineal resection for primary rectal adenocarcinoma by a minimally invasive approach were included. Exclusion criteria were lack of research authorization, stage IV or recurrent rectal cancer, and emergency surgery. Risk factors for conversion were investigated using logistic regression. A subgroup analysis of obese patients (BMI 30 kg/m2 or more) was performed. Results A total of 600 patients were included in the analysis. The overall conversion rate was 9·2 per cent. Multivariable analysis showed a 72 per cent lower risk of conversion when patients had robotic surgery (odds ratio (OR) 0·28, 95 per cent c.i. 0·15 to 0·52). Obese patients experienced a threefold higher risk of conversion compared with non‐obese patients (47 versus 24·4 per cent respectively; P < 0·001). Robotic surgery was associated with a reduced risk of conversion in obese patients (OR 0·22, 0·07 to 0·71). Conclusion Robotic surgery was associated with a lower risk of conversion in patients undergoing minimally invasive rectal cancer surgery, in both obese and non‐obese patients.

Inequalities in access to minimally invasive general surgery: a comprehensive nationwide analysis across 20 years

“…However, other groups and we have reported conversion rates e.g. for colectomy [28,40] and associated risk factors [63]. Lastly, national data of Switzerland might just be partly generalizable to other countries, especially with different healthcare systems.…”

Comment on: Risk factors for conversion in laparoscopic and robotic rectal cancer surgery

“…We appreciate the work by Crippa et al . finding that robotic surgery for rectal cancer was associated with a lower risk of conversion.…”

Author response to: Is robotic approach associated with a lower risk of conversion in rectal cancer surgery compared with laparoscopic approach?

“…We would like to thank our colleagues Jia et al . for their thoughtful comments on our study of conversion in robotic versus laparoscopic rectal cancer surgery. Risk factors for conversion depicted by our multivariate analysis were male gender, BMI above 30 kg/m 2 , stage II and III cancer, and previous abdominal surgery, which can be translated into clinical practice as narrow pelvis, thicker mesentery, advanced tumours and presence of adhesions.…”