engleski

The impact of conversion on short term outcome in laparoscopic colorectal resections

Background: The possibility of conversion is inevitable in laparoscopic surgery. In laparoscopic colorectal surgery reported conversion rates vary considerably. On the other hand, there is lack of explicit definition of conversion. Today, 20 years after introduction of laparoscopic colorectal surgery we have conflicting papers on short and long term impact of conversion. Aim: The goal of this paper is to compare short term outcome in colorectal operations performed and finished by laparoscopy with those that were converted to open surgery. Methods: An analysis of prospectively collected data of 67 patients who underwent laparoscopic colorectal resection by one senior surgeon due to colorectal cancer was done. The operative results and short- term outcomes for patients in conversion group were compared with those who are finished by laparoscopy. Results: Of 68 laparoscopic procedures, 13.2 % (9pts) was converted. Majority of conversion (7 pts) were preemptive due to T4 (5 pts) and bulky tumor (2 pts). In 2 pts we had a reactive conversion, as a result of uncontrolled bleeding and in other case uretheric injury. All conversion occurred after defining the major vascular pedicle and urether. There were no significant differences between the converted and laparoscopy group for age, BMI and ASA score. Male preponderance was observed in the conversion group (male 7/female 2). All converted operation were procedure on rectum and rectosigmoid part of colon. Operative times were similar (lap. 192.5 min. /conv. 165 min.), and conversion group were not associated with greater blood loss and transfusion requirements. Postoperative morbidity was no higher after conversion, only one patient had postoperative complication like pelvic absces. Hospital stay is similar, for lap. 11 days (range 6-23) and converted 12 days (7-28) patients. Conclusion: It is important to emphasize that conversion to open surgery should not be regarded as a failure, but presents extension of surgical treatment. The results of our study conducted on small number of patients suggest that there is no difference in short-term outcome in conversion and laparoscopic resection group for colorectal cancer, although the majority were preemptive conversions. Further confirmation is required.

laparoscopic colorectal resection; conversion

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