M A Gok, PhD, Mb, ChB, M I Malik, M M Sadat, S J Ward, U A Khan. Macclesfield District General Hospital.
Introductions
Colorectal cancer is the third most commonest and the second most lethal malignancy in the UK. Since the introduction of laparoscopic colectomy in 1990, laparoscopic colorectal resection have become routine practise. The potential benefits of laparoscopic surgery are well documented. Laparoscopic open conversion has been reported to occur in 5 – 21 % of cases. The aim of the study is to assess laparoscopic open conversion at a single institution.
Methods & Procedures
This is a retrospective study carried out since 2008 at Macclesfield District General Hospital. Descriptive demography, co-morbidities, and surgical outcomes were collected for all elective colorectal resections. Laparoscopic and open colorectal resections carried out since 2008 were used as controls.
|
Lap(n=208) |
Open (n=316) | lap-open (n=51 | Kruskal-Wallis test | |
| M:F | 110:98 | 187:129 | 34:17 | NS |
| age (yrs) | 70.7 | 71.6 | 68.3 | NS |
| BMI | 24.8 | 26.7 | 27.5 | p<0.001 |
| ASA | 2 | 2 | 2 | NS |
| Op time (mins) | 189.3 | 136.0 | 213.0 | p<0.001 |
| LOS (days) | 7.0 | 10.0 | 9.0 | p<0.001 |
| 1st yr survival | 93.1% | 89.7% | 95.9% | Logrank p =NS |
| 3rd yr survival | 82.6% | 77.3% | 91.1% | |
| 5th yr survival | 75.4% | 71.0% | 91.1% |
Conclusion
The overall laparoscopic-open conversions occurred in 19.7 % of laparoscopic colorectal resections, and this has reduced to 7.6 % for the year 2013. Causes of conversion included: early learning curve, unfavourable patient habitus (especially males), technical difficulties (inability to localize tumour), equipment failure, significant adhesions of previous surgery, tumour fixity, other visceral involvement, intra-operative event (iatrogenic injury, bleeding), anaesthetic compromise.