Skip to main content

Advertisement

Log in

Laparoscopic Rectal Resection for Cancer: Effects of Conversion on Short-Term Outcome and Survival

Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Laparoscopic rectal resection (LRR) is an oncologically safe procedure. The impact of conversion to open surgery on outcomes has not been fully elucidated. The aim of the study is to compare short- and long-term outcomes of converted (CR) and not converted (NCR) patients undergoing LRR.

Methods

Data were drawn from a prospective database of LRR performed between 1999 and 2008. Statistical analysis employed the chi-squared or Wilcoxon test and Kaplan–Meier estimation.

Results

Of 173 patients undergoing LRR, 26 (15%) required conversion. No differences in age, gender, American Society of Anesthesiologists (ASA) score, and T and N stages were observed between CR and NCR patients. Conversion was associated with higher body mass index (BMI) (27.3 versus 24.9 kg/m2, P < 0.001) and American Joint Committee on Cancer (AJCC) stage IV (26.9% versus 4.8%, P < 0.001), and resulted in longer operative time (342 versus 285 min, P = 0.006) and increased intraoperative complication rate (31% versus 5%, P < 0.001). No differences were observed in postoperative outcome between CR and NCR patients. After a mean follow-up of 46 and 36 months, 5-year disease-free survival was 55.7% in CR group and 79.2% in NCR group (P = 0.007). After exclusion of stage IV patients from the analysis, 5-year disease-free survival was 71.1% in CR group and 85.3% in NCR group (P = 0.17), while the overall recurrence rate was 26.3% in CR patients and 11.4% in NCR patients (P = 0.07).

Conclusions

Our study suggests that conversion to open surgery does not affect postoperative outcome, but could have a negative impact on long-term overall recurrence rate. LRR should be performed by experienced surgeons in selected patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Alexander RJ, Jaques BC, Mitchell KG. Laparoscopically assisted colectomy and wound recurrence. Lancet. 1993;341:249–50.

    Article  PubMed  CAS  Google Scholar 

  2. Wexner SD, Cohen SM. Port site metastases after laparoscopic colorectal surgery for cure of malignancy. Br J Surg. 1995; 82:295–8.

    Article  PubMed  CAS  Google Scholar 

  3. Fleshman JW, Nelson H, Peters WR, Kim HC, Larach S, Boorse RR, et al. Early results of laparoscopic surgery for colorectal cancer Retrospective analysis of 372 patients treated by Clinical Outcomes of Surgical Therapy (COST) Study Group. Dis Colon Rectum. 1996;39:S53–8.

    Article  PubMed  CAS  Google Scholar 

  4. Vukasin P, Ortega AE, Greene FL, Steele GD, Simons AJ, Anthone GJ, et al. Wound recurrence following laparoscopic colon cancer resection. Results of the American Society of Colon and Rectal Surgeons Laparoscopic Registry. Dis Colon Rectum. 1996;39:S20–3.

    Article  PubMed  CAS  Google Scholar 

  5. Reilly WT, Nelson H, Schroeder G, Wieand HS, Bolton J, O’Connell MJ. Wound recurrence following conventional treatment of colorectal cancer. A rare but perhaps underestimated problem. Dis Colon Rectum. 1996;39:200–7.

    Article  PubMed  CAS  Google Scholar 

  6. Hughes ES, McDermott FT, Polglase AL, Johnson WR. Tumor recurrence in the abdominal wall scar tissue after large-bowel cancer surgery. Dis Colon Rectum. 1983;26:571–2.

    Article  PubMed  CAS  Google Scholar 

  7. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350:2050–9.

    Article  Google Scholar 

  8. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365:1718–26.

    Article  PubMed  Google Scholar 

  9. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6:477–84.

    Article  PubMed  Google Scholar 

  10. Capussotti L, Massucco P, Muratore A, Amisano M, Bima C, Zorzi D. Laparoscopy as a prognostic factor in curative resection for node positive colorectal cancer: results for a single-institution nonrandomized prospective trial. Surg Endosc. 2004;18:1130–5.

    Article  PubMed  CAS  Google Scholar 

  11. Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359:2224–9.

    Article  PubMed  Google Scholar 

  12. Law WL, Lee YM, Choi HK, Seto CL, Ho JW. Impact of laparoscopic resection for colorectal cancer on operative outcomes and survival. Ann Surg. 2007;245:1–7.

    Article  PubMed  Google Scholar 

  13. Veldkamp R, Gholghesaei M, Bonjer HJ, Meijer DW, Buunen M, Jeekel J, et al. Laparoscopic resection of colon Cancer: consensus of the European Association of Endoscopic Surgery (EAES). Surg Endosc. 2004;18:1163–85.

    Article  PubMed  CAS  Google Scholar 

  14. Bianchi PP, Rosati R, Bona S, Rottoli M, Elmore U, Ceriani C, et al. Laparoscopic surgery in rectal cancer: a prospective analysis of patient survival and outcomes. Dis Colon Rectum. 2007;50:2047–53.

    Article  PubMed  Google Scholar 

  15. Kuhry E, Bonjer HJ, Haglind E, Hop WC, Veldkamp R, Cuesta MA, et al. Impact of hospital case volume on short-term outcome after laparoscopic operation for colonic cancer. Surg Endosc. 2005;19:687–92.

    Article  PubMed  CAS  Google Scholar 

  16. Senagore AJ, Delaney CP, Madboulay K, Brady KM, Fazio VW. Laparoscopic colectomy in obese and nonobese patients. J Gastrointest Surg. 2003;7:558–61.

    Article  PubMed  Google Scholar 

  17. Tekkis PP, Senagore AJ, Delaney CP. Conversion rates in laparoscopic colorectal surgery: a predictive model with, 1253 patients. Surg Endosc. 2005;19:47–54.

    Article  PubMed  CAS  Google Scholar 

  18. Tan PY, Stephens JH, Rieger NA, Hewett PJ. Laparoscopically assisted colectomy: a study of risk factors and predictors of open conversion. Surg Endosc. 2008;22:1708–14.

    Article  PubMed  CAS  Google Scholar 

  19. Slim K, Pezet D, Riff Y, Clark E, Chipponi J. High morbidity rate after converted laparoscopic colorectal surgery. Br J Surg. 1995;82:1406–8.

    Article  PubMed  CAS  Google Scholar 

  20. Gervaz P, Pikarsky A, Utech M, Secic M, Efron J, Belin B, et al. Converted laparoscopic colorectal surgery. Surg Endosc. 2001;15:827–32.

    Article  PubMed  CAS  Google Scholar 

  21. Chan AC, Poon JT, Fan JK, Lo SH, Law WL. Impact of conversion on the long-term outcome in laparoscopic resection of colorectal cancer. Surg Endosc. 2008;22:2625–30.

    Google Scholar 

  22. Moloo H, Mamazza J, Poulin EC, Burpee SE, Bendavid Y, Klein L, et al. Laparoscopic resections for colorectal cancer: does conversion survival? Surg Endosc. 2004;18:732–5.

    Article  PubMed  CAS  Google Scholar 

  23. Ptok H, Steinert R, Meyer F, Kröll KP, Scheele C, Köckerling F, et al. Long-term oncological results after laparoscopic, converted and primary open procedures for rectal carcinoma. Results of a multicenter observational study. Chirurg. 2006;77:709–17.

    Article  PubMed  CAS  Google Scholar 

  24. Gonzalez R, Smith CD, Mason E, Duncan T, Wilson R, Miller J, et al. Consequences of conversion in laparoscopic colorectal surgery. Dis Colon Rectum. 2006;49:197–204.

    Article  PubMed  Google Scholar 

  25. Casillas S, Delaney CP, Senagore AJ, Brady K, Fazio VW. Does conversion of a laparoscopic colectomy adversely affect patient outcome? Dis Colon Rectum. 2004;47:1680–5.

    Article  PubMed  Google Scholar 

  26. Agha A, Fürst A, Iesalnieks I, Fichtner-Feigl S, Ghali N, Krenz D, et al. Conversion rate in 300 laparoscopic rectal resections and its influence on morbidity and oncological outcome. Int J Colorectal Dis. 2008;23:409–17.

    Article  PubMed  CAS  Google Scholar 

  27. Morino M, Parini U, Giraudo G, Salval M, Brachet Contul R, Garrone C. Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg. 2003;237:335–42.

    Article  PubMed  Google Scholar 

  28. Uehara K, Yamamoto S, Fujita S, Akasu T, Moriya Y. Surgical outcomes of laparoscopic vs open surgery for rectal carcinoma–a matched case-control study. Hepatogastroenterology. 2006;53:531–5.

    PubMed  Google Scholar 

  29. Agha A, Fürst A, Hierl J, Iesalnieks I, Glockzin G, Anthuber M, et al. Laparoscopic surgery for rectal cancer: oncological results and clinical outcome of 225 patients. Surg Endosc. 2008;22:2229–37.

    Article  PubMed  Google Scholar 

  30. Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol. 2007;25:3061–8.

    Article  PubMed  Google Scholar 

  31. Tekkis PP, Senagore AJ, Delaney CP, Fazio VW. Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg. 2005;242:83–91.

    Article  PubMed  Google Scholar 

  32. Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, et al. Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet. 2004;363:1187–92.

    Article  PubMed  Google Scholar 

  33. Breukink S, Pierie J, Wiggers T. Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev. 2006;(4):CD005200.

  34. Thorpe H, Jayne DG, Guillou PJ, Quirke P, Copeland J, Brown JM, et al. Patient factors influencing conversion from laparoscopically assisted to open surgery for colorectal cancer. Br J Surg. 2008;95:199–205.

    Article  PubMed  CAS  Google Scholar 

  35. Belizon A, Sardinha CT, Sher ME. Converted laparoscopic colectomy: what are the consequences? Surg Endosc. 2006;20:947–51.

    Article  PubMed  CAS  Google Scholar 

  36. Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A, et al. The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg. 2008;248:1–7.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

The authors thank Elizabeth Corrao for revising the manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Matteo Rottoli MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rottoli, M., Bona, S., Rosati, R. et al. Laparoscopic Rectal Resection for Cancer: Effects of Conversion on Short-Term Outcome and Survival. Ann Surg Oncol 16, 1279–1286 (2009). https://doi.org/10.1245/s10434-009-0398-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-009-0398-4

Keywords

Navigation