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

Abstract

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.

Keywords: Conversion, Laparoscopy, Open surgery, Colon cancer, Rectal cancer, Morbidity, Mortality, Predictors, Recurrence, Survival

Core tip: Several randomized controlled trials have reported the short-term advantages of laparoscopic resection compared to open resection for both colon and rectal cancer. In addition, there is evidence showing the non-inferiority of the laparoscopic approach in colon and rectal cancer surgery in long-term survival. Conversion to open surgery has been reported in up to 30% of laparoscopic colorectal cancer resections. However, both short and long-term outcomes in these patients are unclear. Therefore, we discuss the currently available evidence of the impact of conversion of laparoscopic resection for colon and rectal cancer on both short-term outcomes and long-term survival.