BACKGROUND: Conversion rates following laparoscopic colorectal surgery vary widely between studies, and the outcome of converted patients remains controversial. METHODS: A comprehensive search of the English-language literature was updated until May 1999. RESULTS: Twenty-eight studies on 3232 patients were considered for analysis. The overall conversion rate was 15.38%. Seventy nine percent of the studies did not include a definition for conversion; in these studies, the conversion rate was significantly lower than in the series where a specific definition was considered (13.7% vs 18.9%, chi-square test, p < 0.001). Converted patients had a prolonged hospital stay (11.38 vs 7.41 days) and operative time (209 vs 189 min) in comparison with laparoscopically completed patients (95% confidence interval (CI), 1.70-4.00 and 35.90-37.10, respectively). The factors associated with an increased rate for conversion were left colectomy (Odds Ratio [OR] = 1.061), anterior resection of the rectum (OR = 1.088), diverticulitis (OR = 1.302), and cancer (OR = 2.944) (for each parameter, Wald chi-square value, p < 0.001). CONCLUSIONS: In nonrandomized studies, the rate of laparoscopically completed colorectal resections is close to 85%. Because converted patients have a distinct outcome, a clear definition of conversion is required to compare the results of randomized trials. Such trials should also consider a 20% rate of conversion when estimating the sample size for the desired power level. It is likely that converted patients will have a significant impact on the results of future clinical research in laparoscopic colorectal surgery.
BACKGROUND: Conversion rates following laparoscopic colorectal surgery vary widely between studies, and the outcome of converted patients remains controversial. METHODS: A comprehensive search of the English-language literature was updated until May 1999. RESULTS: Twenty-eight studies on 3232 patients were considered for analysis. The overall conversion rate was 15.38%. Seventy nine percent of the studies did not include a definition for conversion; in these studies, the conversion rate was significantly lower than in the series where a specific definition was considered (13.7% vs 18.9%, chi-square test, p < 0.001). Converted patients had a prolonged hospital stay (11.38 vs 7.41 days) and operative time (209 vs 189 min) in comparison with laparoscopically completed patients (95% confidence interval (CI), 1.70-4.00 and 35.90-37.10, respectively). The factors associated with an increased rate for conversion were left colectomy (Odds Ratio [OR] = 1.061), anterior resection of the rectum (OR = 1.088), diverticulitis (OR = 1.302), and cancer (OR = 2.944) (for each parameter, Wald chi-square value, p < 0.001). CONCLUSIONS: In nonrandomized studies, the rate of laparoscopically completed colorectal resections is close to 85%. Because converted patients have a distinct outcome, a clear definition of conversion is required to compare the results of randomized trials. Such trials should also consider a 20% rate of conversion when estimating the sample size for the desired power level. It is likely that converted patients will have a significant impact on the results of future clinical research in laparoscopic colorectal surgery.
Authors: P M Falk; R W Beart; S D Wexner; A G Thorson; D G Jagelman; I C Lavery; O B Johansen; R J Fitzgibbons Journal: Dis Colon Rectum Date: 1993-01 Impact factor: 4.585
Authors: C Huscher; G Silecchia; E Croce; G A Farello; E Lezoche; M Morino; M Azzola; F Feliciotti; P Rosato; M Tarantini; N Basso Journal: Surg Endosc Date: 1996-09 Impact factor: 4.584
Authors: J W Fleshman; H Nelson; W R Peters; H C Kim; S Larach; R R Boorse; W Ambroze; P Leggett; R Bleday; S Stryker; B Christenson; S Wexner; A Senagore; D Rattner; J Sutton; A P Fine Journal: Dis Colon Rectum Date: 1996-10 Impact factor: 4.585
Authors: Jimmy C M Li; Janet F Y Lee; Simon S M Ng; Raymond Y C Yiu; Sophie S F Hon; Wing Wa Leung; Ka Lau Leung Journal: Int J Colorectal Dis Date: 2010-06-08 Impact factor: 2.571
Authors: Avinash Bhakta; Marcel Tafen; Owen Glotzer; Jonathan Canete; A David Chismark; Brian T Valerian; Steven C Stain; Edward C Lee Journal: Surg Endosc Date: 2015-08-15 Impact factor: 4.584
Authors: C A Sartori; A D'Annibale; G Cutini; C Senargiotto; D D'Antonio; A Dal Pozzo; M Fiorino; G Gagliardi; B Franzato; G Romano Journal: Tech Coloproctol Date: 2007-05-25 Impact factor: 3.781
Authors: Sherief Shawki; Badma Bashankaev; Paula Denoya; Christina Seo; Eric G Weiss; Steven D Wexner Journal: Surg Endosc Date: 2009-03-06 Impact factor: 4.584