Journal of the anus, rectum and colon · 2025
Risk Factors for Conversion to an Open Surgery during Laparoscopic Surgery for Patients with Colon Cancer with Body Mass Index ≥25 kg/m2.
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Tsuchiya Yuki, Sugimoto Kiichi, Nojiri Shuko, Kojima Yutaka, Sakamoto Kazuhiro, Fujii Yoshiaki, Takeshita Hiroaki, Taketa Takashi, Akagi Tomonori, Nakajima Kentaro, Nakamura Takatoshi, Kagawa Yoshinori, Ohnuma Shinobu, Inomata Masafumi, Yamamoto Seiichiro, Naitoh Takeshi
Аннотация
OBJECTIVES: The purpose of this study was to identify factors associated with conversion to an open procedure during laparoscopic colectomy in patients with body mass index (BMI) ≥25 kg/m2. The effects of conversion on long-term outcomes were evaluated.
METHODS: In a multicenter cohort study conducted under the auspices of the Japan Society of Laparoscopic Colorectal Surgery, clinicopathological data were examined for 887 patients with BMI ≥25 kg/m2 who underwent laparoscopic surgery for colon cancer. Risk factors for conversion to an open procedure were estimated using a logistic model after parameter selection using a least absolute shrinkage and selection operator (lasso) model. Long-term outcomes were compared after inverse probability weighting (IPW) estimation.
RESULTS: Among the 887 patients who underwent laparoscopic colectomy, 31 patients (3.5%) required conversion to an open procedure. In multivariate analysis, preoperative BMI ≥27.5 kg/m2, comorbidity-hypertension, blood loss, and simultaneous resection of adjacent organs were independent factors for conversion. After IPW estimation, there were no significant differences in recurrence-free, cancer-specific and overall survival between the conversion (+) and (-) groups.
CONCLUSIONS: In obese patients with the factors identified in this study, surgeons should consider the possibility of conversion to open surgery. Long-term outcomes in patients with BMI ≥25 kg/m2 did not differ between patients who underwent conversion and those who did not. Therefore, conversion to an open procedure was not detrimental in Japanese patients with BMI ≥25 kg/m2.
METHODS: In a multicenter cohort study conducted under the auspices of the Japan Society of Laparoscopic Colorectal Surgery, clinicopathological data were examined for 887 patients with BMI ≥25 kg/m2 who underwent laparoscopic surgery for colon cancer. Risk factors for conversion to an open procedure were estimated using a logistic model after parameter selection using a least absolute shrinkage and selection operator (lasso) model. Long-term outcomes were compared after inverse probability weighting (IPW) estimation.
RESULTS: Among the 887 patients who underwent laparoscopic colectomy, 31 patients (3.5%) required conversion to an open procedure. In multivariate analysis, preoperative BMI ≥27.5 kg/m2, comorbidity-hypertension, blood loss, and simultaneous resection of adjacent organs were independent factors for conversion. After IPW estimation, there were no significant differences in recurrence-free, cancer-specific and overall survival between the conversion (+) and (-) groups.
CONCLUSIONS: In obese patients with the factors identified in this study, surgeons should consider the possibility of conversion to open surgery. Long-term outcomes in patients with BMI ≥25 kg/m2 did not differ between patients who underwent conversion and those who did not. Therefore, conversion to an open procedure was not detrimental in Japanese patients with BMI ≥25 kg/m2.