eP403 - The Incidence and Impact of Conversions After Minimally Invasive Extended Colorectal Resections

Purpose/Background: The majority of minimally invasive colorectal resections require a segment of the colon or rectum to be resected. However, in a proportion of patients due to disease or treatment related factors, extended resections including both the colon and rectum are necessary. These extended resections are technically challenging and can be associated with a higher risk of conversion and perioperative morbidity. We evaluated the outcomes of patients undergoing minimally invasive extended resections (colon and rectum with and without reestablishment of intestinal continuity) including the incidence of conversion, the factors associated with conversion and its impact on perioperative outcomes utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) targeted proctectomy dataset.Methods/Interventions: The ACS-NSQIP targeted proctectomy dataset was analyzed from 2016 to 2020, utilizing the relevant CPT codes. All laparoscopic (Lap), laparoscopic w/ open assist, robotic (rob), robotic w/ open assist cases were included and compared with surgeries with unplanned conversion to open approach. Demographics, pre-operative, perioperative variables and post operative outcomes were collected. Univariate and multivariate analyses were performed to adjust for available confounders.Results/Outcomes: A cohort of 2962 patients was analyzed, which included 2300 (78%) laparoscopic and 662 (22%) robotic resections.The mean age of the cohort was 48 years, 54% were male, 26% had a BMI >30 kg/m2, 91% cases were elective and there were 78% Caucasian, 4% African American and 6% Hispanic patients. Conversion was required in 294 (9%) patients and there was no significant difference between laparoscopic (11%) and robotic (6%) resections.Patients undergoing conversion were more likely to have medical comorbidity (ASA 3-4: 62% vs 47%), obesity BMI >30 kg/m2 (44% vs 25%), malignant pathology (32% vs 24%) and underwent a laparoscopic approach (11% vs 6%). (Table) After adjusting for available confounders in the multivariate analysis a BMI >30 kg/m2 (p < 0.001) was independently associated with conversion.Postoperative complications occurred in 23.4% of patients. Compared to patients that were not converted, patients undergoing conversion had a longer length of stay (mean 6.8 vs 8.8 days; p= < 0.001), a higher incidence of major (15% vs 24%; p=P < 0.001) and minor (13% vs 19%; p=0.005) complications. The incidence of readmission (22% vs 21%; p=0.36) and return to operating room (6% vs 8%; p=0.91) were similar between the two groups.In the adjusted analysis, however conversions to an open approach were not associated with major (OR 1.3; 95CI: 0.89-1.92) or minor (OR 1.4; 95CI: 0.95-2.07) complications. Patient and disease factors including male gender, obesity, smoking, disseminated cancer and non-elective surgery were independently associated with increased major perioperative morbidity.Conclusion/

Discussion: Minimally invasive extended resections of the colon and rectum have a similar rate of conversion to open as compared to segmental resections. Conversion to an open approach does not have necessarily have an impact on perioperative morbidity. Patient obesity continues to be a challenge, adversely impacting conversion rates and incidence of postoperative complications.Analysis of factors associated with conversion after minimally invasive extended colon resections