Predicting conversion in laparoscopic colorectal surgery. Fellowship training may be an advantage

Area of Science:

• Colorectal Surgery
• Minimally Invasive Surgery
• Surgical Outcomes

Background:

• Laparoscopic colorectal surgery offers advantages over open procedures, but effectiveness hinges on conversion rates.
• Predicting conversion is crucial for optimizing laparoscopic colorectal surgery outcomes.

Purpose of the Study:

• To prospectively validate a clinical model designed to predict conversion in laparoscopic colorectal surgery.
• To assess the model's performance in a new cohort, including procedures by a fellowship-trained surgeon.

Main Methods:

• A previously developed multivariable logistic regression model was applied prospectively to 248 laparoscopic colorectal procedures.
• The model's predictive accuracy was evaluated, considering patient factors like obesity and malignancy, and surgeon experience.

Main Results:

• The overall conversion rate remained stable (8.9% vs 9.0%).
• The model showed limitations in distinguishing risk based on weight and malignancy in the follow-up group.
• A fellowship-trained surgeon demonstrated comparable conversion rates despite operating on higher-risk patients, suggesting training may overcome experience gaps.
• Combined data (615 cases) showed the model effectively stratifies patients into low, medium, and high risk for conversion (2.9%, 8.1%, 20% respectively).

Conclusions:

• The clinical model is a valid predictor of conversion to open surgery in laparoscopic colorectal procedures.
• Fellowship training may equip surgeons with sufficient skills to minimize early practice learning curve effects.
• External validation of this predictive model by independent centers is warranted.