Top

Published in:

01-05-2017

Conversions in laparoscopic surgery for rectal cancer

Authors: Martijn H. G. M. van der Pas, Charlotte L. Deijen, Gabor S. A. Abis, Elly S. M. de Lange-de Klerk, Eva Haglind, Alois Fürst, Antonio M. Lacy, Miguel A. Cuesta, Hendrik J. Bonjer, For the COLOR II study group

Published in: Surgical Endoscopy | Issue 5/2017

Abstract

Background

Laparoscopic surgery offers patients with rectal cancer short-term benefits and similar survival rates as open surgery. However, selecting patients who are suitable candidates for laparoscopic surgery is essential to prevent intra-operative conversion from laparoscopic to open surgery. Clinical and pathological variables were studied among patients who had converted laparoscopic surgeries within the COLOR II trial to improve patient selection for laparoscopic rectal cancer surgery.

Methods

Between January 20, 2004, and May 4, 2010, 1044 patients with rectal cancer enrolled in the COLOR II trial and were randomized to either laparoscopic or open surgery. Of 693 patients who had laparoscopic surgery, 114 (16 %) were converted to open surgery. Predictive factors were studied using multivariate analyses, and morbidity and mortality rates were determined.

Results

Factors correlating with conversion were as follows: age above 65 years (OR 1.9; 95 % CI 1.2–3.0: p = 0.003), BMI greater than 25 (OR 2.7; 95 % CI 1.7–4.3: p < 0.001), and tumor location more than 5 cm from the anal verge (OR 0.5; CI 0.3–0.9). Gender was not significantly related to conversion (p = 0.14). In the converted group, blood loss was greater (p < 0.001) and operating time was longer (p = 0.028) compared with the non-converted laparoscopies. Hospital stay did not differ (p = 0.06). Converted procedures were followed by more postoperative complications compared with laparoscopic or open surgery (p = 0.041 and p = 0.042, respectively). Mortality was similar in the laparoscopic and converted groups.

Conclusions

Age above 65 years, BMI greater than 25, and tumor location between 5 and 15 cm from the anal verge were risk factors for conversion of laparoscopic to open surgery in patients with rectal cancer.

Clinical outcomes of Surgical therapy study group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350(20):2050–2059CrossRef

Buunen M, Veldkamp R, Hop WC et al (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10(1):44–52CrossRefPubMed

Jayne DG, Guillou PJ, Thorpe H et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J ClinOncol 25(21):3061–3068CrossRef

Lacy AM, Garcia-Valdecasas JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359(9325):2224–2229CrossRefPubMed

Kang Sung-Bum, Park Ji Won, Jeong Seung-Yong et al (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11(7):637–645CrossRefPubMed

Van der Pas MH, Haglind E, Cuesta MA et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II trial): short-term outcomes of a randomised trial. Lancet Oncol 14(3):210–218CrossRefPubMed

Bonjer HJ, Deijen CL, Abis GA et al (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372(14):1324–1332CrossRefPubMed

Stevenson AR, Solomon MJ, Lumley JW et al (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer. JAMA 314(13):1356–1363CrossRefPubMed

Fleshman J, Branda M, Sargent DJ et al (2015) Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathological outcomes. JAMA 314(13):1346–1355CrossRefPubMedPubMedCentral

10.

Yamamoto S, Fukunaga M, Miyajima N et al (2009) Impact of conversion on surgical outcomes after laparoscopic operation for rectal carcinoma: a retrospective study of 1,073 patients. J Am Coll Surg 208:383–389CrossRefPubMed

11.

Lelong B, Bege T, Esterni B et al (2007) Short-term outcome after laparoscopic or open restorative mesorectal excision for rectal cancer: a comparative cohort study. Dis Colon Rectum 51:385–391

12.

Buunen M, Bonjer HJ, Hop WC et al (2009) Color II: a randomised clinical trial comparing laparoscopic and open surgery for rectal cancer. Dan Med Bull 56(2):89–91PubMed

13.

Wibe A, Syse A, Andersen E, Tretli S, Myrvold HE, Søreide O, Norwegian Rectal Cancer Group (2004) Oncological outcomes after total mesorectal excision for cure for cancer of the lower rectum: anterior vs. abdominoperineal resection. Dis Colon Rectum 47(1):48–58CrossRefPubMed

14.

Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24(5):1205–1210CrossRefPubMed

15.

Lacy AM, Tasende MM, Delgado S, Fernandez-Hevia M, Jimenez M, De Lacy B, Castells A, Bravo R, Wexner SD, Heald RJ (2015) Transanal total mesorectal excision for rectal cancer: outcomes after 140 Patients. J Am Coll Surg 221(2):415–423CrossRefPubMed

16.

Veltcamp Helbach M, Deijen CL, Velthuis S, Bonjer HJ, Tuynman JB, Sietses C (2016) Transanal total mesorectal excision for rectal carcinoma: short-term outcomes and experience after 80 cases. Surg Endosc 30(2):464–470CrossRefPubMed

17.

Makino T, Shukla PJ, Rubino F, Milson JW (2012) The impact of obesity on perioperative outcomes after laparoscopic colorectal resection. Ann Surg 255(2):228–236CrossRefPubMed

18.

Ballal M, David G, Willmott S et al (2009) Conversion after laparoscopic cholecystectomy in England. Surg Endosc 23:2338–2344CrossRefPubMed

19.

Anderson RE (2014) Short-term complications and long-term morbidity of laparoscopic and open appendicectomy in a national cohort. BJS 101:1135–1142CrossRef

20.

Tekkis PP, Senagore AJ, Delaney CP (2005) Conversion rates in laparoscopic colorectal surgery. Surg Endosc 19:47–54CrossRefPubMed

21.

Graily K, Markar SR, Karthikesalingam A, Aboud R et al (2013) Laparoscopic versus open colorectal resection in the elderly population. Surg Endosc 27:19–30CrossRef

22.

Taylor E, Thomas J, Whitehouse L, Quirke P, Jayne D (2013) Population-based study of laparoscopic colorectal cancer surgery 2006–2008. Br J Surg 100(4):553–560CrossRefPubMedPubMedCentral

23.

Tekkis P, Senagore A, Delancy C (2005) Conversion rates in laparoscopic colorectal surgery: a predictive model with 1253 patients. Surg Endosc 19(1):47–54CrossRefPubMed

24.

Agha A, Fürst A, Iesalnieks I, Fichtner-Feigl S (2008) Conversion rate in 300 laparoscopic rectal resections and its influence on morbidity and oncological outcome. Int J Colorectal Dis 23:409–417CrossRefPubMed

25.

Ogiso S, Yamaguchi T, Hata H, Fukuda M, Ikai I, Yamato T, Sakai Y (2011) Evaluation of factors affecting the difficulty of laparoscopic anterior resection for rectal cancer: “narrow pelvis” is not a contraindication. Surg Endosc 25(6):1907–1912CrossRefPubMed

26.

Akiyoshi T, Kuroyanagi H, Oya M, Konishi T, Fukuda M, Fujimoto Y, Ueno M, Miyata S, Yamaguchi T (2009) Factors affecting the difficulty of laparoscopic total mesorectal excision with double stapling technique anastomosis for low rectal cancer. Surgery 146(3):483–489CrossRefPubMed

27.

Targarona EM, Balague C, Pernas JC, Martinez C, Berindoague R, Gich I, Trias M (2008) Can we predict immediate outcome after laparoscopic rectal surgery? Multivariate analysis of clinical, anatomic, and pathologic features after 3-dimensional reconstruction of the pelvic anatomy. Ann Surg 247(4):642–649CrossRefPubMed

28.

Shawki S, Bashankaev B, Denoya P, Seo C, Weiss EG, Wexner SD (2009) What is the definition of “conversion” in laparoscopic colorectal surgery? Surg Endosc 23(10):2321–2326CrossRefPubMed

29.

Blikkendaal MD, Twijnstra ARH, Stiggelbout AM, Beerlage HP, Bemelman WA, Jansen FW (2013) Achieving consensus on the definition of conversion to laparotomy: a Delphi study among general surgeons, gynecologists, and urologists. Surg Endosc 27(12):4631–4639CrossRefPubMed

30.

Yang C, Wexner SD, Safar B et al (2009) Conversion in laparoscopic surgery: does intraoperative complication influence outcome? Surg Endosc 23:2454–2458CrossRefPubMed

31.

Miskovic D, Ni M, Wyles SM, Tekkis P, Hanna GB (2012) Learning curve and case selection in laparoscopic colorectal surgery: systematic review and international multicenter analysis of 4852 cases. Dis Colon Rectum 55(12):1300–1310CrossRefPubMed

32.

Guillou PJ, Quirke P, Thorpe H, Walker J et al (2005) Short-term outcomes of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC ClASICC trial): multicentre, randomized controlled trial. Lancet 365(9472):1718–1726CrossRefPubMed

33.

www.clinicalaudit.nl—Dutch Surgical Colorectal Audit Jaarrapportage 2010, 2011, 2012, 2013 and 2014

34.

Miskovic D, Wyles SM, Ni M, Darzi AW, Hanna GB (2010) Systematic review on mentoring and simulation in laparoscopic colorectal surgery. Ann Surg 252(6):943–951CrossRefPubMed

35.

Dalton SJ, Ghosh AJ, Zafar N, Riyad K, Dixon AR (2010) Competency in laparoscopic colorectal surgery is achievable with appropriate training but takes time: a comparison of 300 elective resections with anastomosis. Colorectal Dis 12(11):1099–1104CrossRefPubMed

36.

Schlachta CM, Mamazza J, Gregoire R, Burpee SE, Pace RT, Poulin EC (2003) Predicting conversion in laparoscopic colorectal surgery. Fellowship training may be an advantage. Surg Endosc 17(8):1288–1291CrossRefPubMed

37.

Scarpinata R, Aly EH (2013) Does robotic rectal cancer surgery offer improved early postoperative outcomes? Dis Colon Rectum 56:253–262CrossRefPubMed

Title: Conversions in laparoscopic surgery for rectal cancer
Authors: Martijn H. G. M. van der Pas
Charlotte L. Deijen
Gabor S. A. Abis
Elly S. M. de Lange-de Klerk
Eva Haglind
Alois Fürst
Antonio M. Lacy
Miguel A. Cuesta
Hendrik J. Bonjer
For the COLOR II study group
Publication date: 01-05-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 5/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-5228-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Conversions in laparoscopic surgery for rectal cancer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2017

A research agenda for the European Association for Endoscopic Surgeons (EAES)

Effects and results of fibrin sealant use in 1000 laparoscopic sleeve gastrectomy cases

Will laparoscopic lysis of adhesions become the standard of care? Evaluating trends and outcomes in laparoscopic management of small-bowel obstruction using the American College of Surgeons National Surgical Quality Improvement Project Database

Erratum to: Outcomes of concomitant ventral hernia repair performed during bariatric surgery

Don’t fix it if it isn’t broken: a survey of preparedness for practice among graduates of Fellowship Council-accredited fellowships

Endoscopic gastric atrophy is strongly associated with gastric cancer development after Helicobacter pylori eradication