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Does the number of operating specialists influence the conversion rate and outcomes after laparoscopic colorectal cancer surgery?

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Abstract

Background

Laparoscopic techniques in colorectal surgery have been widely utilised due to short-term patient benefits but conversion to open surgery is associated with adverse short- and long-term patient outcomes. The aim of this study was to investigate the influence of dual specialist operating on the conversion rate and patient outcomes following laparoscopic colorectal surgery.

Methods

A prospectively populated colorectal cancer surgery database was reviewed. Cases were grouped into single or dual consultant procedures. Cluster analysis and odds ratio (OR) were used to identify risk factors for conversion. Primary outcome measures were conversion to open and five year overall survival (OS) calculated using the Kaplan–Meier log-rank method.

Results

750 patients underwent laparoscopic colorectal cancer resection between 2002 and 2015 (median age 73, 319 (42.5%) female, 282 (37.6%) rectal malignancies, 135 patients (18%) had two consultants). The single surgeon conversion rate was 20.4% compared to 5.5% for dual operating (OR 4.4, 95% CI 1.87–10.2, p < 0.001). There were no demographic or tumour differences between the laparoscopic/converted and number of surgeon groups. Two-step cluster analysis identified cluster I (lower risk) 406 patients, 8% converted and cluster II (higher risk) 261 patients, conversion rate 30%. Median follow-up was 48 months (range 0–168). Five-year OS was significantly inferior for both converted and single surgeon cases (63% vs. 77%, p < 0.001 and 61% vs. 70%, p = 0.033, respectively).

Conclusion

In selected colorectal cancer patients operated by fully trained laparoscopic surgeons, we observed a reduction in conversion with associated long-term survival benefit from dual operating specialists.

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Author information

Authors and Affiliations

  1. Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, BA21 4AT, UK

    Nader K. Francis, Nathan J. Curtis, Louise Crilly, Emma Noble, Tamsin Dyke, Richard Dalton, Andrew Allison & Jonathan Ockrim

  2. Faculty of Science, University of Bath, Wessex House 3.22, Bath, BA2 7AY, UK

    Nader K. Francis

  3. Department of Surgery and Cancer, St Mary’s Hospital, Imperial College London, Level 10, Praed Street, London, W2 1NY, UK

    Nathan J. Curtis

  4. Information Management Team, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, BA21 4AT, UK

    Rob Hipkiss

  5. Faculty of Health and Life Sciences, University of Liverpool, Brownlow Hill, Liverpool, L69 3BX, UK

    Emad Salib

  6. Aidmedical Statistical Support http://www.aidmedical.co.uk

    Emad Salib

Authors
  1. Nader K. Francis
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  2. Nathan J. Curtis
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  3. Louise Crilly
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  4. Emma Noble
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  7. Richard Dalton
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  8. Andrew Allison
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  10. Jonathan Ockrim
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Corresponding author

Correspondence to Nader K. Francis.

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Disclosures

Prof. Francis, Mr. Curtis, Dr. Crilly, Miss. Noble, Dr. Dyke, Mr. Hipkiss, Mr. Dalton, Mr. Allison, Dr. Salib and Mr. Ockrim confirm they have no conflicts of interest or financial ties to disclose.

Electronic supplementary material

Below is the link to the electronic supplementary material.

464_2018_6097_MOESM1_ESM.tif

Supplementary material 1 (TIF 1662 KB) Activity and conversion rate across the study timeframe. No significant difference in conversion rate is seen between years (p = 0.109)

464_2018_6097_MOESM2_ESM.tif

Supplementary material 2 (TIF 1200 KB) Overall survival for the entire cohort displayed by histopathologically determined tumour stage. More advanced tumours are seen to have lower OS (p = 0.062)

464_2018_6097_MOESM3_ESM.tif

Supplementary material 3 (TIF 1191 KB) Overall survival for cases completed laparoscopically displayed by tumour stage. Again, as expected, OS is observed to mirror staging data (p = 0.105)

464_2018_6097_MOESM4_ESM.tif

Supplementary material 4 (TIF 1055 KB) Supplementary Figure 2c - Overall survival for converted cases displayed by tumour stage. Once more long term survival follows tumour staging results (p = 0.105)

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Francis, N.K., Curtis, N.J., Crilly, L. et al. Does the number of operating specialists influence the conversion rate and outcomes after laparoscopic colorectal cancer surgery?. Surg Endosc 32, 3652–3658 (2018). https://doi.org/10.1007/s00464-018-6097-0

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  • DOI: https://doi.org/10.1007/s00464-018-6097-0

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