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Influence of conversion on the perioperative and oncologic outcomes of laparoscopic resection for rectal cancer compared with primarily open resection

机译：与初次开腹手术相比，转换对腹腔镜直肠癌切除术围手术期和肿瘤学结局的影响

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Background: This study aimed to evaluate the influence of conversion on perioperative and short- and long-term oncologic outcomes in laparoscopic resection for rectal cancer and to compare these with those for an open control group. Methods: The data of 276 consecutive patients who underwent surgery for rectal cancer between 2006 and 2010 at a single institution were prospectively collected. Of the 276 patients, 114 underwent primarily open surgery, and 162 underwent laparoscopic surgery (on an intention-to-treat basis). Of the 162 laparoscopic patients, 38 (23.5 %) underwent conversion to open surgery. The three groups of patients were compared: the conversion surgery group, the open surgery group, and the completed laparoscopy surgery group. Results: The converted patients had more wound infections (18.4 vs 4.8 %, p = 0.009), but the wound infection rate in the primarily open group also was significantly higher than in the laparoscopic resection group (p = 0.007). No further differences in perioperative morbidity, including anastomotic leakage, were found. The perioperative 30-day mortality rate was comparable between all the groups (0.6 vs 2.6 vs 2.6 %, nonsignificant difference). The oncologic parameters such as number of harvested lymph nodes and rate of R0 resection were equal in all the groups. The completed laparoscopy group had a shorter hospital stay [12 vs 16 days in the primarily open group (p = 0.02) vs 15 days in the converted group (p = 0.03)]. The rates for survival, local recurrence (4.5 vs 3 vs 3 %), and metachronous metastasis (10.1 vs 9.3 vs 9 %) did not differ significantly between the three groups after a period of 3 years. Conclusion: Conversion to open surgery in laparoscopic rectal resection has no negative effect on perioperative or long-term oncologic outcome.
机译：背景：本研究旨在评估直肠癌在腹腔镜手术中转换对围手术期，短期和长期肿瘤学结局的影响，并将其与开放对照组进行比较。方法：前瞻性收集2006年至2010年在同一机构接受手术的276例连续直肠癌患者的数据。在276例患者中，有114例主要接受了开放手术，而162例接受了腹腔镜手术（意向性治疗）。在162例腹腔镜患者中，有38例（23.5％）接受了开腹手术。比较了三组患者：转换手术组，开放手术组和完成腹腔镜手术组。结果：转换后的患者伤口感染率更高（18.4 vs 4.8％，p = 0.009），但初次开放组的伤口感染率也明显高于腹腔镜切除组（p = 0.007）。没有发现围手术期发病率的进一步差异，包括吻合口漏。所有组的围手术期30天死亡率相当（0.6 vs. 2.6 vs. 2.6％，差异无统计学意义）。在所有组中，肿瘤学参数，例如收获的淋巴结数目和R0切除率均相等。完全腹腔镜检查组的住院时间较短（初次开放组为12天vs 16天（p = 0.02），而转换组为15天（p = 0.03）]。三年后，三组的生存率，局部复发率（4.5 vs 3 vs 3％）和异时转移（10.1 vs 9.3 vs 9％）之间没有显着差异。结论：腹腔镜直肠切除术转为开放手术对围手术期或长期肿瘤学结局没有负面影响。

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