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13.02.2018 | Ausgabe 8/2018

Surgical Endoscopy 8/2018

Does the number of operating specialists influence the conversion rate and outcomes after laparoscopic colorectal cancer surgery?

Surgical Endoscopy > Ausgabe 8/2018
Nader K. Francis, Nathan J. Curtis, Louise Crilly, Emma Noble, Tamsin Dyke, Rob Hipkiss, Richard Dalton, Andrew Allison, Emad Salib, Jonathan Ockrim
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00464-018-6097-0) contains supplementary material, which is available to authorized users.
Oral presentation at the European Association of Endoscopic Surgeons Congress, Frankfurt, Germany, June 2017.



Laparoscopic techniques in colorectal surgery have been widely utilised due to short-term patient benefits but conversion to open surgery is associated with adverse short- and long-term patient outcomes. The aim of this study was to investigate the influence of dual specialist operating on the conversion rate and patient outcomes following laparoscopic colorectal surgery.


A prospectively populated colorectal cancer surgery database was reviewed. Cases were grouped into single or dual consultant procedures. Cluster analysis and odds ratio (OR) were used to identify risk factors for conversion. Primary outcome measures were conversion to open and five year overall survival (OS) calculated using the Kaplan–Meier log-rank method.


750 patients underwent laparoscopic colorectal cancer resection between 2002 and 2015 (median age 73, 319 (42.5%) female, 282 (37.6%) rectal malignancies, 135 patients (18%) had two consultants). The single surgeon conversion rate was 20.4% compared to 5.5% for dual operating (OR 4.4, 95% CI 1.87–10.2, p < 0.001). There were no demographic or tumour differences between the laparoscopic/converted and number of surgeon groups. Two-step cluster analysis identified cluster I (lower risk) 406 patients, 8% converted and cluster II (higher risk) 261 patients, conversion rate 30%. Median follow-up was 48 months (range 0–168). Five-year OS was significantly inferior for both converted and single surgeon cases (63% vs. 77%, p < 0.001 and 61% vs. 70%, p = 0.033, respectively).


In selected colorectal cancer patients operated by fully trained laparoscopic surgeons, we observed a reduction in conversion with associated long-term survival benefit from dual operating specialists.

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Supplementary material 1 (TIF 1662 KB) Activity and conversion rate across the study timeframe. No significant difference in conversion rate is seen between years (p = 0.109)
Supplementary material 2 (TIF 1200 KB) Overall survival for the entire cohort displayed by histopathologically determined tumour stage. More advanced tumours are seen to have lower OS (p = 0.062)
Supplementary material 3 (TIF 1191 KB) Overall survival for cases completed laparoscopically displayed by tumour stage. Again, as expected, OS is observed to mirror staging data (p = 0.105)
Supplementary material 4 (TIF 1055 KB) Supplementary Figure 2c - Overall survival for converted cases displayed by tumour stage. Once more long term survival follows tumour staging results (p = 0.105)
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