Impact of conversion on outcome in laparoscopic colorectal cancer surgery

Oncological outcomes following minimally invasive surgery for pathological N2M0 colorectal cancer: A propensity score-matched analysis

INTRODUCTION

Whether minimally invasive surgery (MIS) is safe and effective for patients with N2M0 colorectal cancer (CRC) remains controversial. This study aimed to compare short- and long-term outcomes between MIS and open surgery (Open) groups for patients with pathological (p)N2M0 CRC, and evaluate the oncological outcomes of MIS for pN2M0 CRC.

MATERIALS AND METHODS

We retrospectively analyzed 125 consecutive patients with pN2M0 CRC who underwent curative surgery between 2010 and 2017, using propensity score-matching (PSM) analysis.

RESULTS

Median follow-up was 59.4 months. After PSM, we enrolled 68 patients (n = 34 in each group). The conversion rate was 9.6% for the entire patient cohort and 5.9% for the matched cohort. In colon cancer (CC), short-term outcomes were similar between groups. On the other hand, in rectal cancer (RC), estimated blood loss, rate of anastomosis leakage, and length of postsurgical stay were lower in the MIS group than the Open group. R0 resection was achieved in all patients with MIS. No surgical mortality was encountered in any group. No significant differences were found between groups in terms of 3-year local recurrence rate, overall survival, cancer-specific survival, or recurrence-free survival among the entire patient cohort or the matched cohort, regardless of the primary tumor site (CC or RC). Surgical approach (MIS vs Open) had no significant influence on survival outcomes.

CONCLUSIONS

MIS is a safe and effective option for patients with pN2M0 CRC, with acceptable short- and long-term outcomes comparable to the open approach. MIS can be considered for patients with pN2M0 CRC.

Impact of prior abdominal surgery on short-term outcomes following laparoscopic colorectal cancer surgery: a propensity score-matched analysis

BACKGROUND

Whether laparoscopic surgery after prior abdominal surgery (PAS) is safe and feasible for colorectal cancer (CRC) remains controversial. The present study aimed to evaluate the impact of PAS on short-term outcomes following laparoscopic CRC surgery.

METHODS

We performed retrospective analysis used propensity score-matched analysis to reduce the possibility of selection bias. Participants comprised 1284 consecutive patients who underwent elective laparoscopic CRC surgery between 2010 and 2020. Patients were divided into two groups according to PAS. Patients with PAS were then matched to patients without these conditions. Short-term outcomes were evaluated between groups in the overall cohort and matched cohort, and risk factors for conversion to laparotomy and severe postoperative complications were analyzed.

RESULTS

After propensity score matching, we enrolled 762 patients (n = 381 in each group). Before matching, significant group-dependent differences were observed in sex, age, primary tumor site, pathological (p) T stage, and type of procedure. No significant difference was found between groups in terms of rate of conversion to laparotomy, estimated blood loss, rate of extended resection, length of postoperative stay, and postoperative complications. After matching, estimated operative time was significantly longer in the PAS group (p = 0.01). Significant differences were found between groups in terms of reason for conversion to laparotomy. Multivariate analyses identified significant risk factors for conversion to laparotomy as pT stage ≥ 3 (odds ratio [OR] 2.36; 95% confidence interval [CI] 1.05-5.26) and body mass index ≥ 25 kg/m² (OR 3.56; 95% CI 1.07-11.7). Multivariate analyses identified rectum in the primary tumor site as the only significant risk factor for severe postoperative complications (OR 2.37; 95% CI 1.08-5.20).

CONCLUSIONS

Laparoscopic CRC surgery after PAS showed acceptable short-term outcomes compared to Non-PAS. The laparoscopic approach appears safe and feasible for CRC regardless of whether the patient has a history of PAS.

Impact of antithrombotic agents on short-term outcomes following minimally invasive colorectal cancer surgery: a propensity score-matched analysis

BACKGROUND

It remains unclear whether minimally invasive colorectal cancer (CRC) surgery under the suitable management of perioperative antithrombotic therapy (ATT) is safe and feasible in patients treated with chronic ATT. The present study aimed to assess the impact of ATT on short-term outcomes following minimally invasive CRC surgery.

METHODS

We retrospectively analyzed 1495 consecutive patients who underwent elective minimally invasive CRC surgery between 2011 and 2021, using propensity score-matched analysis.

RESULTS

Overall, 230 patients had chronically received ATT. After propensity score matching, we enrolled 412 patients (n = 206 in each group). Before matching, significant group-dependent differences were observed in terms of sex (p < 0.01), age (p < 0.01), American Society of Anesthesiologists' physical status (p < 0.01), body mass index (p < 0.01), and pathological N classification (p = 0.03). The frequencies of overall postoperative complications, bleeding events, and thromboembolic events were significantly higher in the ATT group than in the Non-ATT group (p < 0.01). After matching, no significant differences were found between the groups in terms of clinical or surgical characteristics, or in terms of the frequency of overall postoperative complications, bleeding events, thromboembolic events, length of postoperative stay, or any other postoperative complication. Multivariate analysis identified no significant risk factors for postoperative bleeding events or severe postoperative complications associated with ATT.

CONCLUSIONS

Patients treated with chronic ATT showed acceptable short-term outcomes for minimally invasive CRC surgery compared with those not receiving ATT. Minimally invasive CRC surgery appears safe and feasible under the suitable management of perioperative ATT regardless of whether the patient has a history of ATT.

Long-term Oncologic Outcome After Laparoscopic Converted or Primary Open Resection for Colorectal Cancer: A Systematic Review of the Literature

PURPOSE

The aim of this study was to critically review the current evidence regarding the oncologic outcomes after laparoscopic converted or open resection for colorectal cancer.

MATERIALS AND METHODS

A literature search was performed in Pubmed. Study selection and data acquisition were independently performed by 2 reviewers.

RESULTS

The search strategy yielded a total of 746 articles, resulting in 7 studies eligible for inclusion. A total of 9190 (57 to 8307) patients were included in the open and 238 (17 to 56) in the converted group. In none of the studies, differences were found in disease stage between both groups. There were no significant differences between both groups with regard to overall survival, local recurrence and distant metastasis rate.

CONCLUSIONS

There is currently insufficient evidence that patients who had a laparoscopic resection for colorectal cancer converted to open surgery have a worse oncologic outcome than patients who were primarily treated by an open approach.

Cancer recurrence following conversion during laparoscopic colorectal resections: a meta-analysis

INTRODUCTION

Evidence regarding long-term oncological outcomes following conversion to open surgery (COS) during laparoscopic colorectal resection (LCR) is controversial. The aim of this study is to assess the impact on cancer recurrence of a failed laparoscopic attempt.

METHODS

MEDLINE, Scopus and ISI Web of Knowledge databases were searched for articles reporting data on cancer recurrence in patients undergoing completed LCR and COS. Data were pooled by fixed or random effect modeling, according to the presence of heterogeneity. Primary outcomes were local recurrence (LR) and distance recurrence (DR).

RESULTS

Seven studies involving 2493 patients (completed LCR, n 2201 and COS, n 292) were included. The pooled analysis showed that COS resections have an higher risk of LR (OR 1.97, 95% CI 1.14-3.42, p = 0.1); no difference was found in DR (OR 1.09, 95% CI 0.67-1.77, p = 0.71). However, an higher rate of T4 tumor was present in the converted group (OR 2.62, 95% CI 1.71-4, p = 0.0). Subgroup analysis including studies with T stage matched populations showed no significant statistical difference in LR rate; however, a trend toward higher recurrence was still clear.

CONCLUSION

There is no consistent evidence that a failed laparoscopic attempt does not result in a poorer oncological outcome; therefore, a careful selection of patients for LCR for cancer is required.

Conversion of laparoscopic colorectal resection for cancer: What is the impact on short-term outcomes and survival?

Laparoscopic resection for colon and rectal cancer is associated with quicker return of bowel function, reduced postoperative morbidity rates and shorter length of hospital stay compared to open surgery, with no differences in long-term survival. Conversion to open surgery is reported in up to 30% of patients enrolled in randomized control trials comparing open and laparoscopic colorectal resection for cancer. In this review, reasons for conversion are anatomical-related factors, disease-related-factors and surgeon-related factors. Body mass index, local tumour extension and co-morbidities are independent predictors of conversion. The current evidence has shown that patients with converted resection for colon cancer have similar outcomes compared to patients undergoing a laparoscopic completed or open resection. The few studies that have assessed the outcomes after conversion of laparoscopic rectal resection reported significantly higher rates of complications and longer length of hospital stay in converted patients compared to laparoscopically treated patients. No definitive conclusions can be drawn when converted and open rectal resections are compared. Early and pre-emptive conversion appears to have more favourable outcomes than reactive conversion; however, further large studies are needed to better define the optimal timing of conversion. With regard to long-term oncologic outcome, overall and disease-free survival in the case of conversion in laparoscopic colorectal cancer surgery seems to be worse than those achieved in patients in whom resection was successfully completed by laparoscopy. Although a worse long-term oncologic outcome has been suggested, it remains difficult to draw a proper conclusion due to the heterogeneity of the long-term outcomes as well as the inclusion of both colon and rectal cancer patients in most of the studies. Therefore, we discuss the currently available evidence of the impact of conversion in laparoscopic resection for colon and rectal cancer on both short-term outcomes and long-term survival.

Conversion during laparoscopic colorectal resections: a complication or a drawback? A systematic review and meta-analysis of short-term outcomes

PURPOSE

Several studies compared the outcomes of laparoscopically completed colorectal resections (LCR) to those requiring conversion to open surgery (COS). However, a comparative analysis between COS patients and patients undergoing planned open surgery (POS) would be useful to clarify if the conversion can be considered a simple drawback or a complication, being cause of additional postoperative morbidity. The aim of this study is to perform a meta-analysis of current evidences comparing postoperative outcomes of COS patients to POS patients.

METHODS

A systematic search of Medline, ISI Web of Knowledge, and Scopus was performed to identify studies reporting short-term outcomes of COS and POS patients. Primary outcomes were 30-day overall morbidity and length of postoperative hospital stay. Data were analyzed with fixed-effect modeling, and sensitivity analyses were performed to test the robustness of the results.

RESULTS

Twenty studies involving 30,656 patients undergoing POS and 1935 COS patients were selected. The mean conversion rate was 0.17. Similar 30-day overall morbidity and length of postoperative hospital stay were found in COS and POS patients. Wound infection (OR 1.43, 95 % CI 1.12 to 1.83, p < 0.01) was higher in the COS group. Other results were robust. Outcomes were comparable for patients undergoing resection for different natures of the disease (benign vs. malignant) and at different sites (colon vs. rectum).

CONCLUSION

Conversions from laparoscopic to open procedure during colorectal resection are not associated with a poorer postoperative outcome compared to patients undergoing planned open surgery, except for a higher risk of wound infection.