Outcomes of conversion from laparoscopy to open surgery in geriatric patients with colorectal cancer: a case-control study

Purpose: To evaluate the incidence, risk factors and outcomes of conversion from laparoscopic to open surgery in geriatric patients with colorectal cancer (CRC). Methods: All patients subjected to laparoscopic procedures for CRC between 2006 and 2018 were included. Patients older than 70 were divided into these necessitating or not necessitating conversion to open surgery (Con>70 and Lap>70 groups, respectively), and those younger than 70 requiring conversion were evaluated in Con<70 group. The results were compared between Con>70 group and the two other groups. Results: Conversion was significantly more common in Con>70 group than Con<70 group (17.3 vs 9.6%, p=0.011). Although female gender and T4 tumors leading to multivisceral resection were significant risk factors for conversion in univariate analysis, multivariate analysis denied any variable as significant. Perioperative outcomes were significantly worse in Con>70 group than those in Lap>70 group. When conversion groups were compared, the rates of surgical site infection and evisceration were higher in geriatric patients. Pathological results revealed that Con>70 group had more advanced tumors than Lap>70 group regarding pT stage, number of malignant lymph nodes and perineural invasion rate. However, the numbers of harvested lymph nodes were similar in two groups. Conclusion: Conversion rate is higher in geriatric patients, particularly in female patients and those who necessitate multivisceral resections. Conversion worsens the perioperative outcomes in geriatric patients. Finally, since the number of harvested lymph nodes does not decrease with conversion, it probably does not threaten the quality of oncological surgery.