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.

Keywords

• Colorectal cancer,Laparascopic colorectal surgery,Rectum cancer,Radiotherapy,Emergent surgery

Preoperatif radyoterapi uygulanmasının ve acil cerrahinin laparoskopik kolorektal cerrahide açığa geçiş üzerine etkisi: Retrospektif kohort çalışma

Öz

Amaç: Laparoskopik kolorektal kanserlerde açığa geçiş üzerinde neoadjuvan radyoterapi uygulanmasının ve acil şartlarda operasyon yapılmasının etkisi açık değildir. Bu nedenle Neoadjuvan radyoterapi alınması ve acil cerrahinin preoperatif açık cerrahiye geçiş üzerine etkilerini değerlendirmek amaçlandı.
Yöntemler: Ekim 2016 – Ocak 2018 tarihleri arasında aynı cerrahi ekip tarafından ailesel polipozis koli, kolon malign neoplazisi ve rektum malign neoplazisi nedeniyle aynı cerrahi ekip tarafından opere edilen 67 hastanın dosyaları retrospektif olarak incelendi. Laparoskopik tamamlanan veya laparoskopik başlanıp açık cerrahiye geçilen 55 hasta çalışmaya dahil edildi. Çalışmadan çıkarılma kriterleri; direk açık cerrahi uygulanmak, benign veya malign sebeplerle daha önce kolorektal cerrahi uygulanmış olmak, morbid obezite (vücut kitle indeksi >40 kg/m2) ve verilere ulaşılamamaktır. Hastalar demografik özellikleri (yaş, cinsiyet), tümör lokalizasyonu, cerrahinin acil ya da elektif olarak yapılması, preoperatif kemoterapi ve radyoterapi uygulanması, açığa geçiş nedenleri açısından değerlendirildi.
Bulgular: Çalışmaya dahil edilen 55 hastanın 35’i erkek (%63,6), 20’si kadın (%36,4) hastaydı. Hastaların yaş ortalaması 58,4 (13,4) (22 – 80) yaştı. Açığa geçilen hastaların yaş ortalaması 62,86 (8,91) (53 – 73) ve laparoskopik tamamlanan hastaların yaş ortalaması 57,71 (13,84) (22 – 80) yaştı (P=0,216). Hastaların operasyon nedenleri; 3 sağ kolon kanseri (%5,5), 6 sol kolon kanseri (%10.9), 37 rektum kanseri (%67,3), 5 rektosigmoid bölge tümörü (%9,1) ve 4 familiyal polipozis koli sendromu zemininde gelişen adenokarsinomdu (%7,3). 7 hastada cerrahiye laparoskopik başlandı ancak açık cerrahiye geçilmek zorunda kalındı (%12,7). 47 hasta elektif şartlarda (%85,5) opere edilirken 8 hasta acil şartlarda (%14,5) opere edildi. Açığa geçilen 7 hastanın 5’i acil şartlarda opere olurken 2 hasta elektif şartlarda opere edildi (P<0,001). 38 hasta (%69,1) neoadjuvan radyoterapi almamışken (3’ü sadece kemoterapi, 35’i hiçbir neoadjuvan tedavi almadı), 17 hastaya (%39,1) neoadjuvan kemoterapi ve radyoterapi kombinasyonu verilmişti. Açığa geçilen 7 hastadan 1’inde neoadjuvan radyoterapi uygulanmışken, 6’sı neoadjuvan radyoterapi almamıştı (P=0,308).
Sonuç: Laparoskopik kolorektal cerrahi, elektif şartlarda konvansiyonel açık cerrahi kadar başarı ile uygulanabilen bir cerrahidir. Preoperatif radyoterapi alınması ile açığa geçiş arasında ilişki yoktur.

Anahtar Kelimeler

• Rektum kanseri,Kolon kanseri,Laparoskopik cerrahi,Açığa geçiş,Radyoterapi,Acil cerrahi

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