Risk factors for conversion in laparoscopic and robotic rectal cancer surgery

Background The aim of this study was to review risk factors for conversion in a cohort of patients with rectal cancer undergoing minimally invasive abdominal surgery. Methods A retrospective analysis was performed of consecutive patients operated on from February 2005 to April 2018. Adult patients undergoing low anterior resection or abdominoperineal resection for primary rectal adenocarcinoma by a minimally invasive approach were included. Exclusion criteria were lack of research authorization, stage IV or recurrent rectal cancer, and emergency surgery. Risk factors for conversion were investigated using logistic regression. A subgroup analysis of obese patients (BMI 30 kg/m(2) or more) was performed. Results A total of 600 patients were included in the analysis. The overall conversion rate was 9 center dot 2 per cent. Multivariable analysis showed a 72 per cent lower risk of conversion when patients had robotic surgery (odds ratio (OR) 0 center dot 28, 95 per cent c.i. 0 center dot 15 to 0 center dot 52). Obese patients experienced a threefold higher risk of conversion compared with non-obese patients (47 versus 24 center dot 4 per cent respectively; P < 0 center dot 001). Robotic surgery was associated with a reduced risk of conversion in obese patients (OR 0 center dot 22, 0 center dot 07 to 0 center dot 71). Conclusion Robotic surgery was associated with a lower risk of conversion in patients undergoing minimally invasive rectal cancer surgery, in both obese and non-obese patients.