Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
World J Surg. 2011 Jan;35(1):178-85. doi: 10.1007/s00268-010-0824-6.
The reported rates of conversion in laparoscopic colectomy are varied. The incidence of conversion is not, however, well defined. The aim of the present study is to redefine conversion and to analyze differences in outcome.
Treatment parameters of a total of 418 consecutive patients who underwent laparoscopic colonic resection from 2005 to 2007 were analyzed. Treatment was classified as laparoscopic colonic resection, laparoscopy-assisted colonic resection (lap-assisted), and laparoscopic conversion.
There were significant differences in median operating time between laparoscopic colonic resection, lap-assisted, and laparoscopic conversion (125 min, 160 min, and 140 min; p = 0.0001); median hospital length of stay was significantly different (laparoscopic, 5.0 days, versus lap-assisted, 6.0 days, versus laparoscopic conversion, 6.5 days; p = 0.0001); and median incision length was also noted to vary significantly (laparoscopic, 5.0 cm, lap-assisted, 8.0 cm, and conversion, 12.0 cm; p = 0.00001). Multivariate analysis reveals that older age (Odds Ratio [OR] = 1.07, 95% Confidence Interval [CI] = 1.02-1.12), higher Body Mass Index ([BMI], OR = 1.15, 95% CI = 1.03-1.29), and pT stage were significant factors affecting conversion. Disease-free survival for cancers was not influenced by conversion (p = 0.653). The overall complication rate was 16.7% and was significantly increased in lap-assisted cases and in conversion cases (26% versus 13%; p = 0.003).
A consistent definition for conversion in laparoscopic colonic resection is required. Our proposed definitions may provide a solution. The definition of lap-assisted as a separate entity serves as a bridge between laparoscopy and full conversion. Risk factors of age, BMI, and advanced tumor stage are conversion predictors and are associated with increased hospital stay and postoperative morbidity.
腹腔镜结肠切除术中转开腹率的报道结果不一。然而，中转开腹的发生率尚未明确。本研究旨在重新定义中转开腹，并分析其结局差异。
分析了 2005 年至 2007 年间接受腹腔镜结肠切除术的 418 例连续患者的治疗参数。治疗分为腹腔镜结肠切除术、腹腔镜辅助结肠切除术（lap-assisted）和腹腔镜中转开腹。
腹腔镜结肠切除术、lap-assisted 和腹腔镜中转开腹的中位手术时间有显著差异（分别为 125min、160min 和 140min；p=0.0001）；中位住院时间也有显著差异（腹腔镜组为 5.0 天，lap-assisted 组为 6.0 天，中转开腹组为 6.5 天；p=0.0001）；切口长度也有显著差异（腹腔镜组为 5.0cm，lap-assisted 组为 8.0cm，中转开腹组为 12.0cm；p=0.00001）。多变量分析显示，年龄较大（优势比[OR] = 1.07，95%置信区间[CI] = 1.02-1.12）、较高的体重指数（[BMI]，OR = 1.15，95%CI = 1.03-1.29）和 pT 分期是影响中转开腹的显著因素。癌症无病生存率不受中转开腹影响（p=0.653）。总并发症发生率为 16.7%，lap-assisted 病例和中转开腹病例的发生率显著增加（26%比 13%；p=0.003）。
腹腔镜结肠切除术中转开腹需要一个统一的定义。我们提出的定义可能提供了一个解决方案。将 lap-assisted 定义为一个单独的实体，是腹腔镜和完全中转开腹之间的桥梁。年龄、BMI 和晚期肿瘤分期等危险因素是中转开腹的预测因素，与住院时间延长和术后发病率增加相关。
