The impact of conversion on the risk of major complication following laparoscopic colonic surgery: an international, multicentre prospective audit

James Glasbey, Anne van der Pool, Alexandra Rawlings, Luis Sanchez-Guillen, Sara Kuiper, Ionut Negoi, Nicolas Buchs, Dmitri Nepogodiev, Thomas Pinkney, Aneel Bhangu*, 2017 and 2015 European Society of Coloproctology (ESCP) collaborating groups

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

BackgroundLaparoscopy has now been implemented as a standard of care for elective colonic resection around the world. During the adoption period, studies showed that conversion may be detrimental to patients, with poorer outcomes than both laparoscopic completed or planned open surgery. The primary aim of this study was to determine whether laparoscopic conversion was associated with a higher major complication rate than planned open surgery in contemporary, international practice.

MethodsCombined analysis of the European Society of Coloproctology 2017 and 2015 audits. Patients were included if they underwent elective resection of a colonic segment from the caecum to the rectosigmoid junction with primary anastomosis. The primary outcome measure was the 30-day major complication rate, defined as Clavien-Dindo grade III-V.

ResultsOf 3980 patients, 64% (2561/3980) underwent laparoscopic surgery and a laparoscopic conversion rate of 14% (359/2561). The major complication rate was highest after open surgery (laparoscopic 7.4%, converted 9.7%, open 11.6%, P

ConclusionsAppropriate laparoscopic conversion should not be considered a treatment failure in modern practice. Conversion does not appear to place patients at increased risk of complications vs planned open surgery, supporting broadening of selection criteria for attempted laparoscopy in elective colonic resection.

Original languageEnglish
Pages (from-to)69-89
Number of pages21
JournalColorectal Disease
Volume20
DOIs
Publication statusPublished - Sept 2018

Keywords

  • Colon cancer
  • rectal cancer
  • gastrointestinal surgery
  • laparoscopic surgery
  • surgery
  • SHORT-TERM OUTCOMES
  • RANDOMIZED-TRIAL
  • COLORECTAL SURGERY
  • CLINICAL-TRIAL
  • OPEN COLECTOMY
  • OPEN RESECTION
  • RECTAL-CANCER

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