Objective: Conversion rates in colorectal laparoscopic surgery
vary from 8 to 29% in the Literature. An increased postoperative
morbidity and prolonged hospital stay have been described as
the main adverse outcomes in converted patients.
Some studies suggest a negative influence of conversion on the
oncologic outcome, but consistent data are still lacking. This study
evaluates the impact of conversion and analyze the differences in
the oncologic outcome of patients who underwent laparoscopic
resection for colorectal cancer.
Methods: A monocentric retrospective study on 247 patients
operated for colorectal cancer between 2004 and 2007 was performed.
The operative results and long-term outcomes of 44
patients with conversion (22%) were compared both with 200 cases
of successful laparoscopic and 103 open operations. We considered
as conversion a widening or an anticipation of a Pfannenstiel
incision, an upfront midline or transverse laparotomy.
Results: Median follow up was 56 months. Our results show
that the disease-free survival and local recurrence (6.81% in the
converted group) were not significantly worse by the presence of
conversion in laparoscopic cancer resections.
Conclusions: Conversion should not be viewed as a complication
but as a solution to overcome the limitations of laparoscopic
surgery. The adoption of a standardized operative strategy from
an experienced team, together with an early and prompt decision
for conversion and careful patients selection may improve the outcome
of converted patients.
