Effect of preoperative radiotherapy and emergent surgery on conversion in laparoscopic colorectal surgery: A retrospective cohort study

Abstract

Aim: The effects of preoperative radiotherapy and emergent surgery on conversion in laparoscopic colorectal surgery is not clear. We therefore aimed to determine the effects of neoadjuvant radiotherapy and emergent surgery on conversion. Methods: The data of 67 patients, who were operated for familial adenomatosis polyposis coli, colon, and rectum malignant neoplasms by the same surgical team between October 2016 and January 2018 were evaluated retrospectively. Among them, fifty-five laparoscopically finished or converted to open surgery cases were included in the study. The exclusion criteria included cases which began as open surgery, history of previous colorectal surgery for benign or malignant diseases, morbid obesity (body mass index >40 kg/m2 ) and missing data. Demographic values (age, gender), localization of tumor, whether it was an emergent or elective surgery, history of preoperative chemotherapy and radiotherapy, and causes of conversion were evaluated. Results: Among 55 patients, 35 were male (63.6%) and 20 were female 20 (36.4%), with a mean age of 58.4 (13.4) (22 – 80) years. Mean ages of conversion and laparoscopically finished cases were 62.86 (8.91) (53 – 73) and 57.71 (13.84) (22 – 80) years, respectively (P=0,216). The reason for operation was right colon cancer in three patients (5.5%), left colon cancer in six (10.9%), rectum cancer in thirty-seven (67.3%), rectosigmoid junction cancer in five (9.1%) and adenocancer due to familial adenomatous polyposis coli in four patients (7.3%). In seven patients (12.7%), the need for conversion to open surgery arose. Among 55 patients, 47 patients were operated electively (85.5%) and 8 were operated under emergent conditions (14.5%). Of the 7 conversion patients, 5 were operated under emergent conditions and 2 were operated electively (P<0,001). This result showed that conversion rates were higher in emergent surgery patients. Neoadjuvant radiotherapy wasn’t administered to 38 patients (69.1%) (chemotherapy was administered alone to 3 of the patients and 35 patients were not treated with any neoadjuvant therapy), and neoadjuvant chemoradiotherapy combination was administered to 17 patients (39.1%). Among 7 conversion patients, 1 had been administered neoadjuvant radiotherapy while 6 had not (P=0.308). This result showed no statistical differences between patients to whom preoperative radiotherapy were and were not administered. Conclusion: Laparoscopic colorectal surgery can be performed as successfully as conventional open surgery under elective conditions. Preoperative radiotherapy is not related to conversion