Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue,, Cleveland, Ohio, 44195, USA.
Br J Surg. 2013 Nov;100(12):1641-8. doi: 10.1002/bjs.9283.
The impact of conversion on postoperative outcomes of laparoscopic colorectal surgery remains controversial. The purpose of this study was to assess whether a conversion results in increased postoperative morbidity and mortality, and to evaluate whether any specific factors affect the outcomes of converted procedures.
Outcomes of procedures requiring conversion among patients undergoing elective laparoscopic colorectal resection between 1992 and 2011 were compared with those for operations completed laparoscopically. Subset analyses were also performed to evaluate the selective impact of patient-, disease- and treatment-related factors and the timing of conversion during surgery on outcomes. Primary endpoints were postoperative mortality and morbidity.
Of 2483 patients undergoing laparoscopic colorectal resection, 270 (10.9 per cent) required conversion to open surgery. The 30-day postoperative mortality rate was comparable after laparoscopically completed and converted procedures (0.4 versus 0 per cent respectively; P = 0.610). Factors significantly associated with morbidity after conversion were smoking, cardiovascular co-morbidity, previous abdominal operations (particularly colectomy or hysterectomy) and adhesions. Overall morbidity was not affected by conversion (27.0 per cent at 30 days in both groups; P > 0.999). However, patients experiencing morbidity tended to have had earlier conversions: median (range) 40 (15-90) min into surgery versus 50 (15-240) min for those who did not develop morbidity (P = 0.006). The risk of reoperation for postoperative morbidity was higher following conversion because of complications (13 versus 2.9 per cent; P = 0.024).
Conversions of laparoscopic colorectal resection are not associated with increased overall morbidity, regardless of the timing of conversion.
腹腔镜结直肠手术中转对术后结果的影响仍存在争议。本研究旨在评估中转是否会增加术后发病率和死亡率，并评估是否有任何特定因素影响中转手术的结果。
比较 1992 年至 2011 年间接受择期腹腔镜结直肠切除术的患者中转手术与腹腔镜完成手术的患者的手术结果。还进行了亚组分析，以评估患者、疾病和治疗相关因素以及手术中转时机对结果的选择性影响。主要终点是术后死亡率和发病率。
在 2483 例接受腹腔镜结直肠切除术的患者中，有 270 例（10.9%）需要转为开腹手术。腹腔镜完成和中转手术后 30 天的术后死亡率相当（分别为 0.4%和 0%；P=0.610）。与中转后发病率相关的因素有吸烟、心血管合并症、既往腹部手术（特别是结肠切除术或子宫切除术）和粘连。总体发病率不受中转影响（两组术后 30 天发病率分别为 27.0%；P>0.999）。然而，发生并发症的患者中转时间较早：手术中中位数（范围）为 40（15-90）min，而未发生并发症的患者为 50（15-240）min（P=0.006）。由于并发症需要再次手术的风险在中转后更高，分别为 13%和 2.9%（P=0.024）。
腹腔镜结直肠切除中转与总体发病率增加无关，无论中转时机如何。
