Laparoscopic surgery for colorectal cancer in patients with liver cirrhosis: a comparative study on risk of open conversion.

BACKGROUND

Laparoscopic colorectal cancer (CRC) surgery is widely accepted due to its advantages over open surgery. However, its safety and feasibility in patients with liver cirrhosis (LC) remain unclear. This study aimed to evaluate the surgical outcomes of laparoscopic CRC surgery in LC patients compared to non-cirrhotic patients, focusing on the rate of open conversion.

METHODS

This retrospective study analyzed 2523 patients who underwent elective laparoscopic CRC resection between January 2015 and November 2022 at a tertiary hospital. Fifty-five patients with LC were compared with non-cirrhotic patients. Short-term and long-term outcomes were analyzed and the risk factors for open conversion were identified.

RESULTS

The open conversion rate was significantly higher in the LC group than in the non-LC group (9.1% vs. 1.3%, P = 0.001). Advanced LC, higher ASA classes, and larger tumor size were identified as independent risk factors for conversion, with LC class B being the strongest predictor (OR 40.671; 95% CI, 6.763-244.585; P < 0.001). The LC group also exhibited worse intraoperative outcomes and a higher postoperative complication rate (43.6% vs. 24.8%, P = 0.002). However, long-term oncologic outcomes including overall survival and recurrence-free survival did not differ between the two groups.

CONCLUSIONS

LC is a significant risk factor for open conversion and postoperative complications in laparoscopic CRC surgery. Cirrhosis-related physiological changes may render surgical procedures more challenging. Careful patient selection, preoperative risk assessment, and intraoperative decision-making are essential in patients with LC undergoing laparoscopic colorectal resection.