Ten-year experience with laparoscopy on a gynecologic oncology service: Analysis of risk factors for complications and conversion to laparotomy

Objective: The purpose of this study was to analyze our initial 10-year experience with laparoscopy and to determine risk factors for complications and conversions to laparotomy for technical difficulty. Study design: We reviewed the charts of all laparoscopic procedures from January 1991 through December 2000 and divided the procedures into 4 levels on the basis of the degree of difficulty: level 1, diagnostic; level 11, procedures on the uterus and/or adnexa; level 111, second look operations for malignancy; and level IV, lymphadenectomies/other complex procedures. Complications were graded from I (mild) to 5 (death). Standard univariate and multivariate analyses were performed. Results: We identified 1451 evaluable procedures. The number of complications was as follows: grades I to 5, 129 complications (9%); grades 3 to 5, 36 complications (2.5%). On multivariate analysis, older age (P = .03), previous radiation (P = .03), and malignancy (P = .006) were associated with an increased risk of complications grades 3 to 5. Complication rates for grades 3 to 5 for patients with malignancy versus benign disease was 4% versus 1%, respectively. Technical difficulty led to conversion to laparotomy in 105 cases (7%). Previous abdominal surgery (P < .001) significantly increased the rate of conversion to laparotomy; more complex, higher procedure levels were associated with a significant decrease in conversions (P = .005). Conclusion: Both simple and complex laparoscopic procedures can be performed by a gynecologic oncology service with a low rate of complications and conversions to laparotomy. Older age, malignancy, previous radiation therapy, and previous abdominal surgery were identified as significant risk factors for complications and/or conversion and should be taken into account in patient selection, preoperative counseling, and surgical planning. (C) 2004 Elsevier Inc. All rights reserved.