Does conversion affect short-term and oncologic outcomes after laparoscopy for colorectal cancer?

Area of Science:

• Colorectal surgery
• Surgical oncology
• Minimally invasive surgery

Background:

• Conversion from laparoscopic colorectal resection (LCR) to open surgery for cancer has been linked to adverse outcomes.
• Previous studies often lacked sufficient sample size and follow-up duration.

Purpose of the Study:

• To assess the impact of conversion to open surgery on early postoperative results and long-term survival in LCR for nonmetastatic colorectal cancer.

Main Methods:

• Prospective review of LCRs for nonmetastatic colorectal cancer.
• Comparison of converted (CONV) versus exclusively laparoscopic (LAP) groups.
• Minimum 5-year follow-up for oncologic analysis; Kaplan-Meier and multivariate analyses for survival.

Main Results:

• Conversion rate was 10.9%, most commonly due to locally advanced tumors.
• Conversion correlated with longer operative time and greater blood loss, but not increased postoperative morbidity, mortality, or hospital stay.
• The CONV group showed significantly worse 5-year overall survival (OS) and disease-free survival (DFS) compared to the LAP group.

Conclusions:

• Conversion to open surgery does not inherently lead to worse early postoperative outcomes.
• Conversion to open surgery does not independently affect long-term survival.
• Tumor stage (pT4) and lymph node ratio (LNR ≥ 0.25) are independent predictors of survival.