Conversion from laparoscopic to open colonic cancer resection – Associated factors and their influence on long-term oncological outcome

Ptok, H.; Kube, R.; Schmidt, U.; Köckerling, F.; Gastinger, I.; Lippert, H.; the “Colon/Rectum Carcinoma (Primary Tumor)” Study Group,

doi:10.1016/j.ejso.2009.06.006

« Previous Next »European Journal of Surgical Oncology
Volume 35, Issue 12 , Pages 1273-1279, December 2009

Conversion from laparoscopic to open colonic cancer resection – Associated factors and their influence on long-term oncological outcome

H. Ptok
- Institute of Quality Control in Operative Medicine, University Hospital of the Otto von Guericke, University of Magdeburg, Leipziger Strasse 44, 39120 Magdeburg, Germany
- Department of Surgery, Carl Thiem Hospital Cottbus, Thiemstraße 111, 03048 Cottbus, Germany
- Corresponding author. Institute of Quality Assurance in Operative Medicine, University Hospital of the Otto von Guericke, University of Magdeburg, Leipziger Strasse 44, 39120 Magdeburg, Germany. Tel./fax: +49 391 67 14068.
R. Kube
- Institute of Quality Control in Operative Medicine, University Hospital of the Otto von Guericke, University of Magdeburg, Leipziger Strasse 44, 39120 Magdeburg, Germany
- Department of General, Visceral and Vascular Surgery, University Hospital of the Otto von Guericke, University of Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
U. Schmidt
- StatConsult, Goethestraße 1, 39120 Magdeburg, Germany
F. Köckerling
- Institute of Quality Control in Operative Medicine, University Hospital of the Otto von Guericke, University of Magdeburg, Leipziger Strasse 44, 39120 Magdeburg, Germany
- Department of Surgery, Center for Minimally Invasive Surgery, Vivantes Hospital Spandau, Neue Bergstrasse 6, 13585 Berlin, Germany
I. Gastinger
- Institute of Quality Control in Operative Medicine, University Hospital of the Otto von Guericke, University of Magdeburg, Leipziger Strasse 44, 39120 Magdeburg, Germany
- Department of Surgery, Carl Thiem Hospital Cottbus, Thiemstraße 111, 03048 Cottbus, Germany
H. Lippert
- Institute of Quality Control in Operative Medicine, University Hospital of the Otto von Guericke, University of Magdeburg, Leipziger Strasse 44, 39120 Magdeburg, Germany
- Department of General, Visceral and Vascular Surgery, University Hospital of the Otto von Guericke, University of Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
the “Colon/Rectum Carcinoma (Primary Tumor)” Study Group

Accepted 11 June 2009.

Abstract

Purpose

Comparisons of open and laparoscopic colon cancer resection have shown that laparoscopy offers an oncologically safe option. However, there are no data on long-term influence of converted resection, despite conversion rates of up to 30% and the general observation that short-term outcome is significantly worsened. The aim was to compare the long-term results of primary open resection (OR), purely laparoscopic resection (LR-p) and converted resection (LR-c).

Methods

In a prospective study at 282 German hospitals demographic, tumor- and treatment-related data and disease-free survival were compared in the three groups.

Results

8015 of 8307 patients with OR, 280 of 290 patients with LR-p and 55 of 56 patients with LR-c were followed for 39.5months (median). Overall, no statistically significant differences were seen for five-year DFS (74.8%, 81.3% and 65.6%). However, for patients in stage II with conversion, the five-year DFS was significantly poorer (43.3%) than for OR (80.5%; p=0.003) and LR-p patients (92.5%; p=0.001). For stages I and III no differences were observed.

Conclusion

Conversion of laparoscopic colon cancer resection worsens DFS in locally advanced stage II carcinoma. There is a need to reduce the conversion rate by adequate patient selection for laparoscopic resection by experienced surgeons.

Keywords: Colon cancer, Laparoscopic resection, Conversion, Oncological results, Disease-free survival