Risk Factors for Conversion and Morbidity During Initial Experience in Laparoscopic Proctectomies: a Retrospective Study

The aim of this study was to determine the predictable factors for conversion during laparoscopic proctectomies, and for postoperative morbidity, in order to assist in defining the best candidates of patients for initial experience in laparoscopic proctectomies for rectal adenocarcinoma. A retrospective analysis of consecutive patients who underwent laparoscopic rectal resection for rectal adenocarcinoma operated by a single surgeon, between 2005 and 2012, were performed. Predictive factors for conversion and for postoperative morbidity were analyzed using univariate and multivariate analysis. Sixty-nine patients were included. There were 35 (50.7 %) men with a median age of 53 years. Forty-seven patients had tumors located below 8 cm from the anal verge, and sphincter-preserving surgery was performed in 52 (75.4 %) patients. Thirty-four patients were operated in the early period (before 2009). Conversion rate was 17.4 %. In multivariate analysis, the independent predictive factors for conversion were time period (before 2009) (p = 0.007, Exp. 19.9; CI (95 %) 2.2-177.4) and tumors located 8 cm above the anal verge (p = 0.028, Exp. 5.23, CI (95 %) 1.2-22.8). Twenty-two patients (31.9 %) had a complicated postoperative course. Only male gender was associated with postoperative complications (p = 0.01, CI (95 %) 1.3-11.8). Our study showed that conversion rate is influenced by surgeon's experience, and height of the tumor and that male gender is a predisposing factor for a higher morbidity rate. These results suggest that women with low rectal tumors requiring colo-anal anastomosis or abdomino-perineal resection would be the best candidates for early surgeons' experience in laparoscopic proctectomies for rectal adenocarcinoma.