Does Conversion to Open of Laparoscopically Attempted Rectal Cancer Cases Affect Short- and Long-Term Outcomes? A Systematic Review and Meta-Analysis.

Introduction: Laparoscopy for rectal cancer is a challenge as it presents many technical difficulties and requires high level of expertise. That is the reason for the high conversion rate. Reports on outcomes of converted cases after laparoscopic rectal resection for cancer are conflicting.

Aim: The present meta-analysis compares short- and long-term outcomes between converted rectal cancer cases with both open and laparoscopically completed cases.

Method: All studies reporting on outcomes separately for the converted cases were reviewed systematically. Main outcomes were intraoperative complications, procedure duration, short-term mortality and morbidity, length of stay, local recurrence, number of lymph nodes retrieved, and distant metastases. Quality assessment and data extraction were performed independently by 3 reviewers.

Results: Fourteen studies were eligible for analysis, including 10,845 patients. Overall conversion rate was 11.9%. Converted cases had significantly longer duration, hospital stay, and higher rates of wound infection compared with laparoscopic cases. All other outcomes had no difference. When compared with open cases, conversions displayed longer operative times, but there was no other significant difference in the short- or long-term outcomes.

Conclusion: Converted cases seem to have some short-term unfavorable outcomes. Further retrospective analysis of big registries will be helpful for further investigation of converted cases.