Abstract: Objective:To investigate the effects of early and delayed conversion to open surgery on the prognosis after laparoscopic radical resection for colorectal cancer.
Methods:The retrospective cohort study was conducted. The clinicopathological data of 119 patients who were converted to open surgery in laparoscopic radical resection for colorectal cancer in the ZiBo First People′s Hospital from January 2008 to December 2014 were collected. There were 66 males and 53 females, aged from 20 to 84 years, with an average age of 55 years. Of the 119 patients, 82 who were converted to open surgery within 60 minutes after the start of laparoscopic surgery and 37 who were converted to open surgery after 60 minutes since the start of laparoscopic surgery were allocated into early conversion group and delayed conversion group. Observation indicators: (1) surgical situations and postoperative recovery; (2) perioperative complications; (3) Follow-up. Follow-up using telephone interview, mail and outpatient examination was performed to detect patients′ survival once 3 months within 2 years and once a year after 2 years postoperatively up to September 2017. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the independent sample t test. Count data were represented as absolute number or percentage, and comparison between groups was analyzed using the chisquare test or Fisher exact propability. Comparison of ordinal data was analyzed using the rank sum test. The survival rate was calculated using the Kaplan-Meier method and Logrank test was used for survival analysis.
Results:(1) Surgical situations and postoperative recovery: patients in the two group underwent laparoscopic radical resection of colorectal cancer successfully. The operation time, time to first defecation, duration of postoperative hospital stay were (202±44)minutes, (2.6±1.1)days, (9±5)days in the early conversion group and (230±45)minutes, (3.7±2.1)days, (12±6)days in the delayed conversion group, showing statistically significant differences between the two groups (t=-3.106,-3.450,-2.865, P<0.05). The time to first flatus was (1.8±0.6) days and (2.0±0.8) days in the early conversion group and delayed conversion group, respectively, with no statistically significant difference between the two groups (t=-1.245, P>0.05). (2) Perioperative complications: 8.5%(7/82) of patients in the early conversion group had perioperative complications, including 2 of early postoperative inflammatory bowel obstruction, 2 of postoperative incisional infection, 1 of chylous fistula, 1 of urinary retention, 3 of anastomotic fistula; the same patient can merge multiple complications. Patients with perioperative complications were cured after symptomatic and supportive treatment. Meanwhile, 35.1%(13/37) of patients in the delayed conversion group had perioperative complications, including 8 of early postoperative inflammatory bowel obstruction, 3 of postoperative incisional infection, 6 of urinary retention, 3 of anastomotic fistula; the same patient can merge multiple complications. Patients with perioperative complications were cured after symptomatic and supportive treatment. There was a statistically significant difference in the incidence of perioperative complications between the two groups (X²=12.902, P<0.05), a statistically significant difference in the early postoperative inflammatory bowel obstruction and urinary retention between the two groups (P<0.05), and no statistically significant difference in the postoperative incisional infection, chylous fistula, anastomotic fistula between the two groups (P>0.05). (3) Follow-up: 112 out of 119 patients were followed up for 5.2-101.9 months, with a median time of 32.1 months. The 5year survival rate was 70.5% and 63.6% in the 79 patients of early conversion group and 33 of delayed conversion group, showing no statistically significant difference between the two groups (X²=0.038, P>0.05).
Conclusions:Delayed conversion after 60 minutes since the start of laparoscopic surgery will lead to the slower recovery of intestinal function and prolonged hospitalization time, and increase the rates of early postoperative inflammatory intestinal obstruction and postoperative urinary retention. Therefore, a comprehensive analysis of the feasibility of laparoscopic surgery in the initial exploration is recommended and a fast decision on early conversion is necessary.