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대장암의 복강경 수술에 있어서 개복전환 위험인자

Risk Factors for Conversion in Laparoscopic Surgery for Colorectal Cancer

대한대장항문학회지 2009년 25권 6호 p.410 ~ 416
이승환 ( Lee Seung-Hwan ) - 경희대학교 의과대학 외과학교실

이길연 ( Lee Kil-Yeon ) - 경희대학교 의과대학 외과학교실
박순도 ( Park Soon-Do ) - 경희대학교 의과대학 외과학교실
박선진 ( Park Sun-Jin ) - 경희대학교 의과대학 외과학교실
이석환 ( Lee Suk-Hwan ) - 경희대학교 의과대학 외과학교실

Abstract


Purpose: Recently, laparoscopic surgery has been performed with increasing frequency in cases of various diseases, including colorectal cancer. However, in some cases, laparoscopic surgery should be converted to open procedures because of several factors. In this study, we tried to find the causes of and the risk factors for conversion to open procedures during colorectal cancer surgery.

Methods: From June 2002 to May 2008, laparoscopic surgery in 324 patients who were diagnosed as having colorectal cancer was performed by two surgeons. Patients were divided into two groups, non-conversion and conversion groups. We investigated the differences in age, sex, presence of preoperative colonic obstruction, tumor invasion (pT stage), and so on between the two groups.

Results: Of the 324 patients, 20 patients experienced an open conversion: 5 of 28 patients who had a colonic obstruction and 15 of 296 patients who had no obstruction (P=0.021). The causes of conversion during the surgery were tumor invasion, peritoneal adhesion, hemorrhage, and cancer perforation. There were 8 conversions out of 92 patients from June 2002 to May 2005 and 12 out of 232 from June 2005 to May 2008 (P=0.231). In regards to the degree of tumor invasion, 9 of 32 who were stage pT4 experienced a conversion to an open procedure (P<0.001). In multivariate analysis, the presence of a colonic obstruction and pT4 stage were meaningful risk factors for conversion to an open procedure.

Conclusion: From this study, we can predict a higher rate of conversion to an open procedure in patients with locally advanced colon cancer, especially when a colonic obstruction is present. Therefore, a careful laparoscopic approach is needed in such patients.

키워드

대장암;복강경;개복 전환
Colorectal cancer;Laparoscopy;Open conversion
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