Is There a Drawback of Converting a Laparoscopic Colectomy in Colon Cancer?
BACKGROUND
Laparoscopic resection is well established in the treatment of colon cancer. However, conversion rates remain high and the impact of conversion is disputed.


MATERIAL AND METHODS
We retrospectively identified 1347 patients who underwent surgery for colon cancer between 2004 and 2014 at our tertiary center. Morbidity and oncological outcomes were compared between patients who underwent successfully completed laparoscopic surgery (LS), planned open surgery (OS), and conversion to open surgery (CS). Long-term analysis included patients with stage I-III disease. In addition, we performed propensity score matching to adjust for the heterogeneity and selection bias between the treatment groups.


RESULTS
Of all patients, 505 underwent LS, 789 underwent OS, and 53 underwent CS, which corresponded to a conversion rate of 9.5%. Conversion was associated with male gender, left-sided tumors, and stage III disease. Length of stay, morbidity, and readmission rates were lower for LS patients. Kaplan-Meier curves demonstrated worse overall, disease-specific, and disease-free survival in CS than LS, with similar outcomes to OS. However, after propensity score matching, CS was only associated with admission duration and the requirement of blood transfusion, whereas survival outcomes were comparable between all groups.


CONCLUSIONS
CS is associated with adverse short- and long-term outcomes compared to LS. However, when accounting for differences in baseline and pathologic features, CS remained only associated with a longer length of stay and more blood transfusions. Because outcomes were comparable between CS and OS, regardless of stage and other risk factors, our data support a surgeon's attempt to perform LS in patients with colon cancer.
['Leijssen|Lieve G J|LGJ|', 'Dinaux|Anne M|AM|', 'Kunitake|Hiroko|H|', 'Bordeianou|Liliana G|LG|', 'Berger|David L|DL|']
D000368:Aged D000369:Aged, 80 and over D003082:Colectomy D003110:Colonic Neoplasms D005260:Female D006801:Humans D010535:Laparoscopy D008297:Male D008875:Middle Aged D011183:Postoperative Complications D057216:Propensity Score D012189:Retrospective Studies
Colon cancer Conversion Morbidity Laparoscopy Prognosis Recurrence