Double complications during laparoscopic surgery for colon cancer when laparoscopic surgery is converted

Dec 26, 2024

Photo source=Getty Images Bank (Hallim University Medical Center)

Laparoscopic surgery for colon cancer has been a stable treatment for a long time, and compared to laparotomy, it has been proven that postoperative pain is less and the recovery period is shorter, but the prognosis of surgery is not inferior. However, a study found that complications may increase if patients who are unfit for laparoscopic surgery are forced to undergo laparoscopic surgery and then switched to laparoscopic surgery.

Professor Kim Jong-wan's research team at Hallym University's East Elastic Heart Hospital confirmed this in the study of 「Comparative analysis of the oncological findings and risk factors for open conversion in laparoscopic surgery for non-transitory colorectal cancer」.

The research team analyzed the risk factors of surgery prognosis and laparoscopic surgery of colon cancer and the group that switched to laparoscopic surgery at a hospital affiliated with Hallym University Medical Center from January 2011 to June 2021. During this period, a total of 2231 people underwent laparoscopic surgery for colon cancer, and 100 patients, 4.5%, of them, switched to laparoscopic surgery and underwent surgery.

The most common reason for laparotomy conversion was intraperitoneal adhesion at 36%, followed by tumor adjacent organ or tissue invasion at 23%, tumor size at 13%, and patient anatomical problems at 12%.

It was found that the laparotomy conversion group was worse after surgery. The overall incidence of complications in the laparoscopic surgery group and the laparoscopic surgery conversion group was 7.6% versus 14%, which was about 1.8 times higher in the conversion group. The incidence of severe complications in grades 3 to 4 was 46.6% vs. 71.4%, 1.5 times higher in the conversion group, and the 5-year recurrence-free survival rate after surgery was 75.7% vs. 61.6%.

In addition, the laparoscopic surgery group and the laparoscopic surgery conversion group had an average operation time of 235 minutes to 255 minutes, the intraoperative blood transfusion rate was 4% to 12%, the size of the tumor was 4cm to 5.4cm, and the number of lymph nodes invading the tumor was 20.9 to 24, and the T stage was also high.

The risk factors for switching to laparoscopic surgery were intestinal obstruction, abdominal surgery history, and T4 stage, in which the tumor invaded the serosal layer or surrounding organs. Intestinal obstruction makes laparoscopic surgery difficult by gas and feces expanding the intestine, and abdominal surgery history increases the risk of intestinal damage during laparoscopic surgery and the possibility of switching to laparoscopic surgery due to adhesion of the surgical site.

Professor Kim Jong-wan said, `This study shows that the conversion to laparoscopic surgery to laparoscopic surgery increases the incidence of total and severe complications.' It is analyzed that the conversion to laparoscopic surgery increases the time of surgery and increases the blood transfusion rate, which increases the physiological stress in the body, and inhibits the immune system and anticancer effect of cells, resulting in poor oncological results", he explained.

Professor Kim said, "The surgeon should fully evaluate the risk factors before laparoscopic surgery for colon cancer and choose the optimal surgical method"However, the rate of conversion from laparoscopic surgery for colon cancer to laparoscopic surgery is up to 23.5%, and the transition from laparoscopic to laparoscopic surgery itself does not affect the prognosis after surgery, so if the transition to laparoscopic surgery is essential, other risk factors must be changed to avoid it."

This research paper was recently published in the SCIE-level European Journal of Surgical Oncology'.