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Conversion of laparoscopic resection for colon cancer has no effect on survival, new data reveal
Friday, December 26 2008 | Comments
What's This?
Among individuals with colon cancer, survival appears to be similar between those requiring conversion of laparoscopic resection to open resection and those who do not, newly published data suggest.According to researchers, although laparoscopic and open resections of colon cancer are considered oncologically equivalent treatment options, conversion of laparoscopic procedures has been shown to be associated with decreased survival in one previous study examining this issue.
To further explore outcome differences between the 2 approaches, they conducted a retrospective review of 174 consecutive patients who were treated with laparoscopic resection of colorectal cancer between 1998 and 2003. Patients were followed for a median of 51 months. Overall survival was the primary endpoint.
Results showed that 143 patients were resected laparoscopically, while 31 required conversion to an open procedure, which resulted in a conversion rate of 17.8%. No statistically significant difference in all-cause mortality was seen between the completed and converted groups (P=.266). The overall survival rates did not differ at 2, 3, and 5 years.
However, there were significant differences in length of hospital stay (median of 3 days in the completed group vs 6 days in the converted group; P<.001) and operative time (160 minutes vs 182 mins; P=.027).
On multivariate analysis, survival was significantly influenced by age (hazard ratio [HR], 1.055 per year; P=.021) and tumor stage (HR, 2.140; P=.017), but conversion was not a significant influence on survival even after taking into account all of the variables included in the Cox proportional hazard model.
The percentage of patients with intraoperative bleeding resulting in blood transfusion was significantly higher in the conversion group as compared with the completed group (19.4% vs 0.7%; P<.001). There were no significant between-group differences in wound infection and other complications, such as postoperative ileus, overt leaks and abscesses, enterotomy, and injury to the ureter and bladder.
"[T]he evidence against laparoscopic resection of colorectal cancer in patients having a high risk of conversion remains controversial," the authors concluded. "Further evidence is needed to determine whether laparoscopy is oncologically safe in a subgroup of patients who are prone to conversion." (Franko J, et al. Surg Endosc 2008;22:2631-2634.)
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