Long term outcome of conversion in laparoscopic colorectal surgery

Objective: Conversion rates in colorectal laparoscopic surgery vary from 8 to 29% in the Literature. An increased postoperative morbidity and prolonged hospital stay have been described as the main adverse outcomes in converted patients. Some studies suggest a negative influence of conversion on the oncologic outcome, but consistent data are still lacking. This study evaluates the impact of conversion and analyze the differences in the oncologic outcome of patients who underwent laparoscopic resection for colorectal cancer. Methods: A monocentric retrospective study on 247 patients operated for colorectal cancer between 2004 and 2007 was performed. The operative results and long-term outcomes of 44 patients with conversion (22%) were compared both with 200 cases of successful laparoscopic and 103 open operations. We considered as conversion a widening or an anticipation of a Pfannenstiel incision, an upfront midline or transverse laparotomy. Results: Median follow up was 56 months. Our results show that the disease-free survival and local recurrence (6.81% in the converted group) were not significantly worse by the presence of conversion in laparoscopic cancer resections. Conclusions: Conversion should not be viewed as a complication but as a solution to overcome the limitations of laparoscopic surgery. The adoption of a standardized operative strategy from an experienced team, together with an early and prompt decision for conversion and careful patients selection may improve the outcome of converted patients.