Risk Factors for Conversion to an Open Surgery during Laparoscopic Surgery for Patients with Colon Cancer with Body...

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Obesity Medicine

Background:

• Laparoscopic colectomy is a standard procedure for colon cancer.
• Obesity (body mass index [BMI] ≥25 kg/m² ) presents surgical challenges.
• Conversion to open surgery may be necessary in complex cases.

Purpose of the Study:

• Identify factors predicting conversion to open surgery during laparoscopic colectomy in obese patients (BMI ≥25 kg/m²).
• Evaluate the impact of conversion on long-term oncological outcomes.

Main Methods:

• Multicenter cohort study of 887 patients with BMI ≥25 kg/m² undergoing laparoscopic colectomy for colon cancer.
• Logistic regression with least absolute shrinkage and selection operator (lasso) for risk factor identification.
• Inverse probability weighting (IPW) for comparing long-term outcomes.

Main Results:

• 3.5% of patients required conversion to open surgery.
• Independent predictors for conversion included preoperative BMI ≥27.5 kg/m², hypertension, blood loss, and adjacent organ resection.
• No significant differences in recurrence-free, cancer-specific, or overall survival between converted and non-converted groups.

Conclusions:

• Surgeons should anticipate conversion in obese patients with identified risk factors.
• Conversion to open surgery is not detrimental to long-term oncological outcomes in this population.
• Laparoscopic colectomy with potential conversion is a safe approach for obese Japanese patients.