Impact of Prior Abdominal Surgery on Rates of Conversion to Open Surgery and Short-Term Outcomes after Laparoscopic Surgery for Colorectal Cancer

• Published in: PloS one 2015-07, Vol.10 (7), p.e0134058-e0134058
• Main Authors: Kim, Ik Yong, Kim, Bo Ra, Kim, Young Wan
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal surgery; Aged; Aged, 80 and over; Antibiotics; Cancer; Cancer patients; Cancer therapies; Colectomy; Colon; Colon cancer; Colonic Neoplasms - surgery; Colorectal cancer; Colorectal carcinoma; Colorectal surgery; Comparative analysis; Conversion; Conversion to Open Surgery - statistics & numerical data; Epidemiology; Female; Gastrectomy; Gastrointestinal surgery; Hospitals; Humans; Hysterectomy; Laparoscopy; Length of Stay; Male; Medicine; Middle Aged; Patients; Rectal Neoplasms - surgery; Rectum; Retreatment; Short term; Studies; Surgery; Surgical outcomes; Treatment Outcome
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0134058

To evaluate the impact of prior abdominal surgery (PAS) on rates of conversion to open surgery and short-term outcomes after laparoscopic surgery for colon and rectal cancers. We compared three groups as follows: colon cancer patients with no PAS (n = 272), major PAS (n = 24), and minor PAS (n = 33), and rectal cancer patients with no PAS (n = 282), major PAS (n=16), and minor PAS (n = 26). In patients with colon and rectal cancers, the rate of conversion to open surgery was significantly higher in the major PAS group (25% and 25%) compared with the no PAS group (8.1% and 8.9%), while the conversion rate was similar between the no PAS and minor PAS groups (15.2% and 15.4%). The 30-day complication rate did not differ among the three groups (28.7% and 29.1% in the no PAS group, 29.2% and 25% in the major PAS group, and 27.3% and 26.9% in the minor PAS group). The mean operative time did not differ among the three groups (188 min and 227 min in the no PAS group, 191 min and 210 min in the major PAS group, and 192 min and 248 min in the minor PAS group). The rate of conversion to open surgery was significantly higher in patients with prior gastrectomy or colectomy compared with the no PAS group, while the conversion rate was similar between the no PAS group and patients with prior radical hysterectomy in patients with colon and rectal cancers. Our results suggest that colorectal cancer patients with minor PAS or patients with prior radical hysterectomy can be effectively managed with a laparoscopic approach. In addition, laparoscopy can be selected as the primary surgical approach even in patients with major PAS (prior gastrectomy or colectomy) given the assumption of a higher conversion rate.