Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2015; 21(18): 5505-5512
Published online May 14, 2015. doi: 10.3748/wjg.v21.i18.5505
Long-term oncologic outcomes of laparoscopic vs open surgery for stages II and III rectal cancer: A retrospective cohort study
Zhen-Xu Zhou, Li-Ying Zhao, Tian Lin, Hao Liu, Hai-Jun Deng, Heng-Liang Zhu, Jun Yan, Guo-Xin Li
Zhen-Xu Zhou, Li-Ying Zhao, Tian Lin, Hao Liu, Hai-Jun Deng, Heng-Liang Zhu, Jun Yan, Guo-Xin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Author contributions: Zhao LY and Zhou ZX contributed equally to this work in the design and preparation of this study and should be considered as co-first authors; Zhao LY, Zhou ZX and Li GX designed the research; Lin T, Deng HJ, Yan J and Li GX performed the surgeries; Lin T, Zhu HL and Liu H collected and analyzed the data; Zhao LY and Zhou ZX wrote the paper.
Supported by National Key Clinical Specialty Construction Project of China, the National High Technology Research and Development Program of China No. 2012AA021103; and the Research Fund of Public Welfare in Health Industry, National Health and Family Planning Commission of China, No. 201502039.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Guo-Xin Li, MD, PhD, Professor, Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou 510515, Guangdong Province, China. gzliguoxin@163.com
Telephone: +86-20-61641682 Fax: +86-20-61641683
Received: November 6, 2014
Peer-review started: November 6, 2014
First decision: November 26, 2014
Revised: January 9, 2015
Accepted: February 12, 2015
Article in press: February 13, 2015
Published online: May 14, 2015
Processing time: 193 Days and 7.5 Hours
Abstract

AIM: To evaluate the 5-year survival after laparoscopic surgery vs open surgery for stages II and III rectal cancer.

METHODS: This study enrolled 406 consecutive patients who underwent curative resection for stages II and III rectal cancer between January 2000 and December 2009 [laparoscopic rectal resection (LRR), n = 152; open rectal resection (ORR), n = 254]. Clinical characteristics, operative outcomes, pathological outcomes, postoperative recovery, and 5-year survival outcomes were compared between the two groups.

RESULTS: Most of the clinical characteristics were similar except age (59 years vs 55 years, P = 0.033) between the LRR group and ORR group. The proportion of anterior resection was higher in the LRR group than that in the ORR group (81.6% vs 66.1%, P = 0.001). The LRR group had less estimated blood loss (50 mL vs 200 mL, P < 0.001) and a lower rate of blood transfusion (4.6% vs 11.8%, P = 0.019) compared to the ORR group. The pathological outcomes of the two groups were comparable. The LRR group was associated with faster recovery of bowel function (2.8 d vs 3.7 d, P < 0.001) and shorter postoperative hospital stay (11.7 d vs 13.7 d, P < 0.001). The median follow-up time was 63 mo in the LRR group and 65 mo in the ORR group. As for the survival outcomes, the 5-year local recurrence rate (16.0% vs 16.4%, P = 0.753), 5-year disease-free survival (DFS) rate (63.0% vs 63.1%, P = 0.589), and 5-year overall survival (OS) rate (68.1% vs 63.5%, P = 0.682) were comparable between the LRR group and the ORR group. Stage by stage, there were also no statistical differences between the LRR group and the ORR group in terms of the 5-year local recurrence rate (stage II: 6.3% vs 8.7%, P = 0.623; stage III: 26.4% vs 23.2%, P = 0.747), 5-year DFS rate (stage II: 77.5% vs 77.6%, P = 0.462; stage III: 46.5% vs 50.9%, P = 0.738), and 5-year OS rate (stage II: 81.4% vs 74.3%, P = 0.242; stage III: 53.9% vs 54.1%, P = 0.459).

CONCLUSION: LRR for stages II and III rectal cancer can yield comparable long-term survival while achieving short-term benefits compared to open surgery.

Keywords: Laparoscopic surgery; Locally advanced rectal cancer; Oncologic outcomes

Core tip: This retrospective study specially evaluates the oncologic outcomes after laparoscopic resection for locally advanced rectal cancer. Results suggest that laparoscopic rectal resection for stage II or III rectal cancer is a safe procedure, yielding comparable 5-year oncologic outcomes to open surgery.