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Long-term oncologic outcome and risk factors after conversion in laparoscopic surgery for colon cancer

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Abstract

Purpose

The goal of this study was to evaluate the long-term oncologic outcomes after laparoscopic converted surgery for patients with colon cancer.

Methods

Retrospective database of consecutive curative-intent laparoscopic-assisted surgery for primary stage I–III colon cancer was reviewed from 2000 to 2013. The patients were divided into non-conversion and conversion groups. The patient characters, operative features, perioperative parameters, pathologic features, and oncologic outcomes were compared.

Results

A total of 4010 patients were included in the study: 3929 in the non-conversion group and 81 (2%) in the conversion group. The median follow-up period was 63.9 months. There were significant differences in age, preoperative clinical T-stage, and tumor size between the groups. In operative details between the two groups, there were also significant differences in access to surgery, tumor location, cancer obstruction, cancer perforation, and estimated blood loss (P < 0.001). The two most common reasons for conversion were adhesion (n = 37, 46%) and bleeding (n = 21, 26%). Multivariate analysis showed that conversion was an independent predictor of both overall survival (OS) (P < 0.001) and disease-free survival (P = 0.003). The 5-year OS rate of the conversion group was 79.6%, and that of the non-conversion group was 96.2% (P < 0.001). The multivariate predictors of conversion were age, type of surgery, cancer obstruction, cancer perforation, and clinical T-stage.

Conclusion

Conversion to open surgery may affect patient survival and recurrence after laparoscopic-assisted surgery for colon cancer. Our data suggest that conversion is associated with poor outcomes, but we should not hesitate to convert it to patients who have difficulty in laparoscopic surgery.

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Author information

Data analysis and drafting the manuscript are attributed to Sung Chul Lee.

Study design, proposal, and responsibility of correspondence are attributed to Jung Wook Huh. All authors revise it critically for content and approve the manuscript.

Correspondence to Jung Wook Huh.

Ethics declarations

This study was reviewed and approved by the appropriate institutional review board at Samsung Medical Center.

Conflict of interest

The authors declare that they have no conflicts of interest.

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Lee, S.C., Huh, J.W., Lee, W.Y. et al. Long-term oncologic outcome and risk factors after conversion in laparoscopic surgery for colon cancer. Int J Colorectal Dis 35, 395–402 (2020). https://doi.org/10.1007/s00384-019-03489-7

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Keywords

  • Colon cancer
  • Laparoscopic-assisted surgery
  • Conversion
  • Long-term outcome