Laparoscopic vs open abdominoperineal resection in the multimodality management of low rectal cancers

Table 1 Clinicopathological features of the included patients

	LAPR		OAPR (%)		P value
	Mean, n	SD (%)	Mean, n	SD (%)
Age (yr)	58.01	11.64	56.78	12.28	0.454
BMI	23.13	3.01	22.97	2.85	0.690
Gender					0.583
Male	55	51.9	51	48.1
Female	51	48.1	55	51.9
ASA score					0.783
I	54	50.9	52	49.1
II	51	48.1	53	50.0
III	1	0.9	1	0.9
Neoadjuvant therapy					1.000
No	80	75.5	80	75.5
Yes	26	24.5	26	24.5
Histology					1.000
Adenocarcinoma	97	91.5	98	92.5
Mucinous adenocarcinoma	9	8.5	8	7.5
Pathological stage					1.000
pCR	2	1.9	3	2.8
I	43	40.6	41	38.7
II	24	22.6	24	22.6
III	25	23.6	25	23.6
IV	12	11.3	13	12.3
Lymphovascular invasion					0.846
No	91	85.8	90	84.9
Yes	15	14.2	16	15.1
Perineural invasion					0.366
No	85	80.2	90	84.9
Yes	21	19.8	16	15.1
Grade					0.451
NA	25	23.6	18	17.0
III/IV	19	17.9	23	21.7
I/II	62	58.5	65	61.3
pT category					0.612
pT0	4	3.8	4	3.8
pT1	12	11.3	15	14.2
pT2	40	37.7	31	29.2
pT3	50	47.2	56	52.8
pN category					0.543
pN0	74	69.8	70	66.0
pN1	23	21.7	22	20.8
pN2	9	8.5	14	13.2
Total examined nodes	12.88	6.93	12.91	5.40	0.974
Distance (cm)	3.87	1.34	3.58	1.28	0.099

LAPR: Laparoscopic abdominoperineal resection; OAPR: Open abdominoperineal resection; BMI: Body mass index; ASA: American Society of Anesthesiologists; pCR: Pathological complete remission.

Table 2 Postoperative recovery

	LAPR		OAPR		P value
	Mean	SD	Mean	SD
Intraoperative blood loss (mL)	93.87	60.04	88.44	55.15	0.494
Operation time (min)	180.83	47.83	172.07	49.16	0.190
Time to first pass of flatus (h)	57.31	7.91	63.51	9.20	0.000
Postoperative analgesia (d)	2.35	0.65	2.66	0.63	0.000
Urinary drainage (d)	6.45	3.40	7.75	1.30	0.000
Postoperative hospital stay (d)	11.15	4.72	12.63	3.96	0.014

LAPR: Laparoscopic abdominoperineal resection; OAPR: Open abdominoperineal resection.

Table 3 Summary of complications

	LAPR	OAPR	P value
	n	n
Abdominal wound infection	3	5	0.721
Perineal wound reintervention	1	2	1.000
Bowel obstruction	1	2	1.000
Urinary retention	2	3	1.000
Ureter damage	1	1	1.000
Urethra damage	1	0	1.000
Parastomal hernia	1	0	1.000
Total	9	13	0.500

LAPR: Laparoscopic abdominoperineal resection; OAPR: Open abdominoperineal resection.

Table 4 Clinicopathological features according to neoadjuvant therapy

	No neoCRT					neoCRT
	LAPR		OAPR		P value	LAPR		OAPR		P value
	Mean, n	SD (%)	Mean, n	SD (%)		Mean, n	SD (%)	Mean, n	SD (%)
Age (yr)	58.41	11.98	57.44	12.86	0.623	56.81	10.64	54.77	10.23	0.483
BMI	23.21	3.00	22.84	2.89	0.431	22.90	3.08	23.37	2.74	0.561
Gender					0.113					0.087
Male	42	52.5%	32	40.0%		13	50.0%	19	73.1%
Female	38	47.5%	48	60.0%		13	50.0%	7	26.9%
ASA score					0.429					0.696
I	42	52.5%	37	46.3%		12	46.2%	15	57.7%
II	38	47.5%	43	53.8%		13	50.0%	10	38.5%
III	0	0.0%	0	0.0%		1	3.8%	1	3.8%
Histology					1.000					1.000
Adenocarcinoma	57	80.3%	56	73.7%		5	50.0%	9	75.0%
Mucinous adenocarcinoma	6	7.5%	6	7.5%		3	11.5%	2	7.7%
Pathological stage					0.884					0.970
pCR	NA		NA			2	7.7%	3	11.5%
I	33	41.3%	33	41.3%		10	38.5%	8	30.8%
II	20	25.0%	20	25.0%		4	15.4%	4	15.4%
III	19	23.8%	19	23.8%		6	23.1%	6	23.1%
IV	8	10.0%	8	10.0%		4	15.4%	5	19.2%
Lymphovascular invasion					0.685					1.000
No	66	82.5%	64	80.0%		25	96.2%	26	100.0%
Yes	14	17.5%	16	20.0%		1	3.8%	0	0.0%
Perineural invasion					0.151					0.701
No	62	77.5%	69	86.3%		23	88.5%	21	80.8%
Yes	18	22.5%	11	13.8%		3	11.5%	5	19.2%
Grade					0.224					0.411
NA	9	11.2%	4			16	61.5%	14	53.8%
III/IV	14	17.5%	20	25.0%		5	19.2%	3	11.5%
I/II	57	71.2%	56	70.0%		5	19.2%	9	34.6%
pT category					0.816					0.196
pT0	0	0.0%	0	0.0%		4	15.4%	4	15.4%
pT1	11	13.8%	5	12.5%		1	3.8%	5	19.2%
pT2	27	33.8%	7	30.0%		13	50.0%	7	26.9%
pT3	42	52.5%	10	57.7%		8	30.8%	10	38.5%
pN category					0.337					0.723
pN0	56	70.0%	53	66.3%		18	69.2%	17	65.4%
pN1	17	21.3%	14	17.5%		6	23.1%	8	30.8%
pN2	7	8.8%	13	16.3%		2	7.7%	1	3.8%
Total retrieved nodes	14.58	6.70	14.11	5.35	0.630	7.65	4.73	9.19	3.59	0.193
Distance (cm)	3.73	1.25	3.55	1.26	0.380	4.33	1.50	3.65	1.35	0.095

LAPR: Laparoscopic abdominoperineal resection; OAPR: Open abdominoperineal resection; BMI: Body mass index; ASA: American Society of Anesthesiologists; pCR: Pathological complete remission; neoCRT: Neoadjuvant chemoradiation.

Table 5 Postoperative recovery according to neoadjuvant therapy

	No neoCRT					neoCRT
	LAPR		OAPR		P value	LAPR		OAPR		P value
	Mean	SD	Mean	SD		Mean	SD	Mean	SD
Intraoperative blood loss (mL)	91.88	63.87	87.94	57.55	0.683	100.00	46.90	90.00	48.00	0.451
Operation time (min)	176.48	48.47	170.25	41.73	0.385	194.23	44.00	177.65	67.85	0.301
Time to first pass of flatus (h)	57.55	7.56	62.93	9.33	0.000	56.58	9.03	65.31	8.68	0.001
Postoperative analgesia (d)	2.39	0.63	2.70	0.64	0.001	2.23	0.71	2.54	0.58	0.094
Urinary drainage (d)	6.63	3.75	7.70	1.07	0.016	5.92	1.96	7.88	1.86	0.001
Postoperative hospital stay (d)	11.41	5.24	12.80	3.94	0.060	10.35	2.48	12.12	4.07	0.064

LAPR: Laparoscopic abdominoperineal resection; OAPR: Open abdominoperineal resection; neoCRT: Neoadjuvant chemoradiation.

Table 6 Summary of complications according to neoadjuvant therapy

	No neoCRT			neoCRT
	LAPR	OAPR	P value	LAPR	OAPR	P value
	n	n		n	n
Abdominal wound infection	3	3	1.000	0	2	0.497
Perineal wound reintervention	0	1		1	1
Bowel obstruction	1	1		0	1
Urinary retention	1	3		1	0
Ureter damage	1	0		0	1
Urethra damage	1	0		0	0
Parastomal hernia	1	0		0	0
Total	7	8	1.000	2	5	0.191

LAPR: Laparoscopic abdominoperineal resection; OAPR: Open abdominoperineal resection; neoCRT: Neoadjuvant chemoradiation.