A meta-analysis to determine the oncological implications of conversion in laparoscopic XXXX surgery.

@entity5 @entity1 @entity14
AIM: Laparoscopic colon and @entity5 surgery is oncologically equivalent to open resection, but the impact of conversion is undetermined. The aim of this study was to assess the oncological outcome and predictive factors associated with conversion. METHOD: A comprehensive search for published studies examining the associated factors and outcome of conversion from laparoscopic to open @entity14 resection was performed adhering to PRISMA guidelines. Only randomised control trials and prospective studies were included. Each study was reviewed and the data extracted. Random-effects methods were used to combine data. RESULTS: Fifteen studies met the inclusion criteria including 5,293 @entity1 . Of these 4,391 @entity1 had a completed laparoscopic resection and 902 were converted to an open resection. The average conversion rate of the studies was 17  9 +/- 10  1%. Meta-analysis showed completed laparoscopic surgery favoured lower 30 day mortality (OR:0  134, 95% CI 0  047-0  385, P<0  0001), lower long term disease recurrence (OR:0  634, 95% CI 0  421-0  701, p<0  023) and lower overall mortality (OR:0  512, 95% CI 0  417-0  629, P<0  0001). Factors negatively associated with completion of laparoscopic surgery were male gender (P=0  011), @entity5 (P=0  017), T3/T4 @entity5 (P=0  009) and node positive disease (P=0  009). Completed laparoscopic surgery was also associated with a lower BMI (mean difference -0  93 SI units, P=0  004). CONCLUSION: The results suggest that conversion from laparoscopic to open @entity14 resection is influenced by @entity1 and @entity5 characteristics and is associated with an adverse peri-operative outcome. Although confounding factors such as advanced @entity5 stage and elevated BMI are present, unsuccessful laparoscopic surgery appears to be associated with an adverse long term oncological outcome. This article is protected by copyright. All rights reserved.
