B. Yerokun1, M. Adam1, Z. Sun1, J. Kim1, S. Sprinkle1, J. Migaly1, C. Mantyh1 1Duke University Medical Center,Department Of Surgery,Durham, NC, USA
Introduction: Limited data exist with regard to the effect of conversion from laparoscopic to open colectomy on oncologic outcomes in colon cancer. The aims of this study were to evaluate perioperative and oncologic outcomes associated with conversion of laparoscopic to open colectomy in the United States.
Methods: The National Cancer Data Base was used to identify patients who underwent colon resection for Stage I-III colon cancer (2010-2012). Patients were stratified into three groups: laparoscopic colectomy (LC), converted laparoscopic to open colectomy (CC), and open colectomy (OC). Multivariable modeling was applied to compare perioperative and oncologic outcomes from CC and LC to open colectomy while adjusting for patient, clinical, and tumor characteristics.
Results: A total of 104,400 patients were included: 40,328 (38.63%) had LC, 6,144 (5.89%) CC, 57,928 (55.48%) OC. The conversion rate was 13.2%. After adjustment, surgical margin status was not significantly different between CC and OC (OR 1.05, 95% CI 0.93-1.19, p=0.44). However, with adjustment, CC was associated with shorter hospital length of stay (-4%, 95% CI -2% to -5%, p<0.0001) and lower odds of 30-day mortality (OR 0.77, 95% CI 0.64-0.94, p=0.01) when compared with OC. In adjusted survival analysis with median follow-up time of 24 months (range 1-51 months), overall survival was similar between the CC and open groups (HR 0.96, 95% CI 0.88-1.05, p=0.34). Compared with OC, LC was associated with improved 30-day mortality (OR 0.47, 95% CI 0.42-0.52, p<0.0001) and overall survival (HR 0.69, 95% CI 0.66-0.73, p<0.0001) after adjustment.
Conclusion: In this nationally representative study, patients who underwent initial laparoscopic attempts at colon resection for non-metastatic colon cancer before conversion to open colectomy had similar oncologic outcomes, and improved short-term outcomes, when compared with standard open colectomy. This analysis demonstrates that laparoscopic colectomy should be considered on all patients without contraindication to laparoscopy, and conversion can be done safely when necessary, without harm to patients.