Document Detail


Laparoscopic rectal resection for cancer: effects of conversion on short-term outcome and survival.
MedLine Citation:
PMID:  19252948     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Laparoscopic rectal resection (LRR) is an oncologically safe procedure. The impact of conversion to open surgery on outcomes has not been fully elucidated. The aim of the study is to compare short- and long-term outcomes of converted (CR) and not converted (NCR) patients undergoing LRR. METHODS: Data were drawn from a prospective database of LRR performed between 1999 and 2008. Statistical analysis employed the chi-squared or Wilcoxon test and Kaplan-Meier estimation. RESULTS: Of 173 patients undergoing LRR, 26 (15%) required conversion. No differences in age, gender, American Society of Anesthesiologists (ASA) score, and T and N stages were observed between CR and NCR patients. Conversion was associated with higher body mass index (BMI) (27.3 versus 24.9 kg/m(2), P < 0.001) and American Joint Committee on Cancer (AJCC) stage IV (26.9% versus 4.8%, P < 0.001), and resulted in longer operative time (342 versus 285 min, P = 0.006) and increased intraoperative complication rate (31% versus 5%, P < 0.001). No differences were observed in postoperative outcome between CR and NCR patients. After a mean follow-up of 46 and 36 months, 5-year disease-free survival was 55.7% in CR group and 79.2% in NCR group (P = 0.007). After exclusion of stage IV patients from the analysis, 5-year disease-free survival was 71.1% in CR group and 85.3% in NCR group (P = 0.17), while the overall recurrence rate was 26.3% in CR patients and 11.4% in NCR patients (P = 0.07). CONCLUSIONS: Our study suggests that conversion to open surgery does not affect postoperative outcome, but could have a negative impact on long-term overall recurrence rate. LRR should be performed by experienced surgeons in selected patients.
Authors:
Matteo Rottoli; Stefano Bona; Riccardo Rosati; Ugo Elmore; Paolo P Bianchi; Antonino Spinelli; Cristina Bartolucci; Marco Montorsi
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Publication Detail:
Type:  Journal Article     Date:  2009-02-28
Journal Detail:
Title:  Annals of surgical oncology     Volume:  16     ISSN:  1534-4681     ISO Abbreviation:  Ann. Surg. Oncol.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-03     Completed Date:  2009-06-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9420840     Medline TA:  Ann Surg Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1279-86     Citation Subset:  IM    
Affiliation:
General Surgery III, University of Milan, Istituto Clinico Humanitas IRCCS, Rozzano, Milan, Italy. matteo.rottoli@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Colectomy / methods,  mortality*
Female
Humans
Laparoscopy
Male
Middle Aged
Neoadjuvant Therapy
Rectal Neoplasms / surgery*,  therapy
Survival Analysis
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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