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Abstract
ObjectiveTo determine the frequency of conversion of laparoscopic abdominoperineal resection (APR) to open surgery and describe the reasons for conversion and perioperative outcomes in patients undergoing surgery for rectal cancer.
Materials and MethodsThis descriptive cross-sectional study was conducted in the Department of General Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan, over six months following ethical approval. A total of 82 patients were enrolled using non-probability consecutive sampling. Patients undergoing attempted laparoscopic APR for rectal cancer were included. Demographic, clinical, intraoperative, and postoperative data were collected using a structured proforma and analysed using SPSS version 26.0. Categorical variables were presented as frequencies and percentages, while continuous variables were reported as mean and standard deviation. The frequency of conversion was calculated with a 95% confidence interval.
ResultsAmong 82 patients undergoing attempted laparoscopic APR, 7 (8.5%) required conversion to open surgery, whereas 75 (91.5%) completed the procedure laparoscopically. Difficult pelvic dissection and inadequate operative exposure were the most frequent reasons for conversion, accounting for 3 (42.9%) cases, followed by locally advanced tumour or adjacent-organ involvement in 2 (28.6%) cases. Bleeding and dense adhesions accounted for 1 (14.3%) case each. The mean operative duration was 242.5 ± 48.7 minutes, and mean estimated blood loss was 310 ± 165 mL. Postoperative complications within 30 days occurred in 15 (18.3%) patients. The mean hospital stay was 7.2 ± 3.1 days.
ConclusionConversion from laparoscopic to open APR occurred in a proportion of patients undergoing surgery for rectal cancer. Difficult pelvic dissection and locally advanced disease were the leading reported reasons. Appropriate patient selection, preoperative assessment, and timely conversion when required may help support safe surgical practice