TY - JOUR
T1 - The impact of conversion on the risk of major complication following laparoscopic colonic surgery
T2 - an international, multicentre prospective audit
AU - The 2017 and 2015 European Society of Coloproctology (ESCP) collaborating groups
AU - van der Pool, Anne
AU - Rawlings, Alexandra
AU - Sánchez-Guillén, Luis
AU - Kuiper, Sara
AU - Negoi, Ionut
AU - Buchs, Nicolas
AU - El-Hussuna, Alaa
AU - Battersby, Nick J.
AU - Buchs, Nicolas C.
AU - Buskens, Christianne
AU - Chaudri, Sanjay
AU - Frasson, Matteo
AU - Gallo, Gaetano
AU - Minaya-Bravo, Ana María
AU - Morton, Dion
AU - Nepogodiev, Dmitri
AU - Pata, Francesco
AU - Singh, Baljit
AU - Zmora, Oded
AU - Perry, Rita
AU - Magill, Laura
AU - Altomare, Donato
AU - Bemelman, Willem
AU - Brown, Steven
AU - Denost, Christianne Buskens Quentin
AU - Knowles, Charles
AU - Laurberg, Søren
AU - Lefevre, Jérémie H.
AU - Möeslein, Gabriela
AU - Pinkney, Tom
AU - Vaizey, Carolynne
AU - Bilali, S.
AU - Bilali, V.
AU - Salomon, M.
AU - Cillo, M.
AU - Estefania, D.
AU - Patron Uriburu, J.
AU - Ruiz, H.
AU - Farina, P.
AU - Carballo, F.
AU - Guckenheimer, S.
AU - Proud, D.
AU - Brouwer, R.
AU - Bui, A.
AU - Gold Deutch, R.
AU - Lavy, R.
AU - Avital, S.
AU - White, I.
AU - Wasserberg, N.
AU - Tulchinsky, H.
N1 - Publisher Copyright:
Colorectal Disease © 2018 The Association of Coloproctology of Great Britain and Ireland
PY - 2018/9
Y1 - 2018/9
N2 - Background: Laparoscopy 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. Methods: Combined 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. Results: Of 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 < 0.001). After case mix adjustment in a multilevel model, only planned open (and not laparoscopic converted) surgery was associated with increased major complications in comparison to laparoscopic surgery (OR 1.64, 1.27–2.11, P < 0.001). Conclusions: Appropriate 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.
AB - Background: Laparoscopy 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. Methods: Combined 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. Results: Of 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 < 0.001). After case mix adjustment in a multilevel model, only planned open (and not laparoscopic converted) surgery was associated with increased major complications in comparison to laparoscopic surgery (OR 1.64, 1.27–2.11, P < 0.001). Conclusions: Appropriate 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.
KW - Colon cancer
KW - gastrointestinal surgery
KW - laparoscopic surgery
KW - rectal cancer
KW - surgery
UR - http://www.scopus.com/inward/record.url?scp=85053824933&partnerID=8YFLogxK
U2 - 10.1111/codi.14371
DO - 10.1111/codi.14371
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C2 - 30255643
AN - SCOPUS:85053824933
SN - 1462-8910
VL - 20
SP - 69
EP - 89
JO - Colorectal Disease
JF - Colorectal Disease
ER -