Totally versus planned conversion laparoscopic colectomy for colorectal cancers: the beginning of the learning curve

Abstract

Background: Colorectal cancers (CRC) are one of the major causes of cancer-related deaths worldwide. Laparoscopic colectomies have many advantages in short-term outcomes in comparison with open colectomies and recently have a long-term oncologic validation. Objectives: This work aimed to compare the short- and medium-term outcomes of TLC and LPCC for CRC at the beginning of the learning curve of laparoscopic colectomy. Materials and Methods: A randomized prospective study has been conducted from November 2018 to November 2020 on 30 patients with CRC were randomized to the total laparoscopic colectomy (TLC) group (15 patients) or laparoscopic-planned conversion colectomy LPCC group (15 patients). The primary outcomes were operative time, intra-operative blood loss, postoperative pain, hospital stay, and the secondary outcomes were early postoperative complications (anastomotic leak, pelvic nerve injuries), tumour recurrence, port-site metastasis, and hernia. Results: There were statistically significant differences in the operative time (244± 40.9min vs. 322 ± 57 min; P <0.001) and in the intra-operative blood loss (240± 118.3 cc vs. 326.7 ± 99.8 cc; P < 0.039). There were no statistically significant differences in the post-operative pain, hospital stay, early postoperative complications, tumour recurrence, port-site metastasis, and hernia. Conclusion: Laparoscopic planned conversion colectomy is a safe and feasible procedure in the management of selected patients with colorectal carcinoma especially at the beginning of the learning curve of laparoscopic colectomy with differences in the operative time and the intra-operative blood loss that need further studies to evaluate these differences and the possibility of being less significant.

Keywords

• laparoscopic colectomy; total; planned conversion; learning curve