Scheidbach Hubert, Garlipp Benjamin, Oberländer Henrik, Adolf Daniela, Köckerling Ferdinand, Lippert Hans
Department of General, Visceral, and Thoracic Surgery, Kreisklinik Bad Neustadt/Saale, Bad Neustadt/Saale, Germany.
J Laparoendosc Adv Surg Tech A. 2011 Dec;21(10):923-7. doi: 10.1089/lap.2011.0298. Epub 2011 Oct 19.
Despite the well-documented safety and effectiveness of laparoscopic colorectal surgery in curative intention, the role of conversion and its impact on short- and long-term outcome after resection of a carcinoma are unclear and continue to give rise to controversial discussion.
Within the framework of a prospective, multicenter observational study (Laparoscopic Colorectal Surgery Study Group), into which a total of 5,863 patients from 69 hospitals were recruited over a period of 10 years, a subgroup of all patients who had undergone curative resection was analyzed with regard to the effects of conversion.
Of the 1409 patients who had undergone curative resection for colorectal carcinoma, conversion had to be performed in 80 (5.7%) cases for the most diverse reasons. The duration of surgery (median: 183 vs. 241 minutes; P<.001) was significantly longer in the conversion group. Perioperatively, significant disadvantages were noted in converted patients in terms of intraoperative blood loss (median: 243 vs. 573 mL, P<.001), need for perioperative blood transfusion (10.8% vs. 33.8%; P<.001), and resumption of bowel movement (median: after 3 vs. 4 days; P<.001). With regard to postoperative morbidity, significant disadvantages were observed in converted patients, in particular in terms of specific surgical complications, including a higher rate of anastomotic insufficiency (5.0% vs. 13.8%; P=.003) and a higher reoperation rate (4.9% vs. 15.0%; P=.001). In the long term, conversion was associated with lower overall survival, but not with poorer disease-free survival.
Significantly higher postoperative morbidity was observed in patients after conversion, in particular in terms of specific surgical complications. In addition, conversion is associated with overall lower survival but not with poorer disease-free survival.
尽管腹腔镜结直肠癌手术在根治性治疗方面的安全性和有效性已有充分记录，但中转手术的作用及其对癌切除术后短期和长期结局的影响尚不清楚，仍在引发争议性讨论。
在一项前瞻性、多中心观察性研究（腹腔镜结直肠癌手术研究组）的框架内，在10年期间共招募了来自69家医院的5863例患者，对所有接受根治性切除的患者亚组进行了中转手术影响的分析。
在1409例行结直肠癌根治性切除的患者中，因各种原因有80例（5.7%）需要中转手术。中转手术组的手术时间（中位数：183 vs. 241分钟；P<0.001）明显更长。围手术期，中转手术患者在术中失血（中位数：243 vs. 573 mL，P<0.001）、围手术期输血需求（10.8% vs. 33.8%；P<0.001）和肠道蠕动恢复（中位数：术后3天 vs. 4天；P<0.001）方面存在明显劣势。关于术后发病率，中转手术患者存在明显劣势，特别是在特定手术并发症方面，包括吻合口漏发生率较高（5.0% vs. 13.8%；P=0.003）和再次手术率较高（4.9% vs. 15.0%；P=0.001）。从长期来看，中转手术与较低的总生存率相关，但与无病生存率较差无关。
中转手术后患者的术后发病率明显更高，特别是在特定手术并发症方面。此外，中转手术与总体较低的生存率相关，但与无病生存率较差无关。
