Biondi Antonio, Grosso Giuseppe, Mistretta Antonio, Marventano Stefano, Tropea Alessandro, Gruttadauria Salvatore, Basile Francesco
*Department of General Surgery, Section of General Surgery and Oncology, School of Medicine †Department "G. F. Ingrassia," Section of Hygiene and Public Health, University of Catania, Catania ‡Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center, Palermo, Italy.
Surg Laparosc Endosc Percutan Tech. 2014 Feb;24(1):e21-6. doi: 10.1097/SLE.0b013e31828f6bc0.
This study investigated risk factors and impact of open conversion on outcomes of 207 consecutive patients who had laparoscopic resection of colorectal cancer at our institution. Conversion occurred in 15.9% of patients, mostly because of invasion to adjacent structures (30.3%), bulky tumor (21.2%), and adhesions (18.2%). Converted patients had significant larger tumor size, advanced stage, increased operative blood loss, time to walk independently, prolonged hospital stay, number of massive hemorrhage, ileus, anastomotic hemorrhage, abdominal hemorrhage, peritonitis/septic shock, and wound infection than completed laparoscopy patients. Factors associated with conversion were obesity [relative risk (RR)=6.92; 95% confidence interval (CI), 1.7-28.09], date of operation (RR=0.37; 95% CI, 0.15-0.95), advanced tumor stage (RR=7.67; 95% CI; 1.19-49.2), size (RR=1.97; 95% CI, 1.42-2.72), and rectum location (RR=2.73; 95% CI, 1.09-6.84). Converted patients had worse cumulative disease-free (P<0.001) and overall survival (P<0.001) than laparoscopic completed patients.
本研究调查了在我院接受腹腔镜结直肠癌切除术的207例连续患者中转开腹手术的危险因素及其对手术结局的影响。15.9%的患者发生了中转开腹，主要原因是侵犯相邻结构（30.3%）、肿瘤体积大（21.2%）和粘连（18.2%）。与完成腹腔镜手术的患者相比，中转开腹的患者肿瘤尺寸显著更大、分期更晚、手术失血量增加、独立行走时间延长、住院时间延长、大出血、肠梗阻、吻合口出血、腹腔出血、腹膜炎/感染性休克及伤口感染的发生率更高。与中转开腹相关的因素包括肥胖[相对危险度（RR）=6.92；95%置信区间（CI），1.7 - 28.09]、手术日期（RR=0.37；95% CI，0.15 - 0.95）、肿瘤晚期（RR=7.67；95% CI，1.19 - 49.2）、肿瘤大小（RR=1.97；95% CI，1.42 - 2.72）及直肠位置（RR=2.73；95% CI，1.09 - 6.84）。与完成腹腔镜手术的患者相比，中转开腹的患者无病累积生存率（P<0.001）和总生存率（P<0.001）更差。
