Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2016; 8(6): 452-460
Published online Jun 27, 2016. doi: 10.4240/wjgs.v8.i6.452
Critical appraisal of laparoscopic vs open rectal cancer surgery
Winson Jianhong Tan, Min Hoe Chew, Angela Renayanti Dharmawan, Manraj Singh, Sanchalika Acharyya, Carol Tien Tau Loi, Choong Leong Tang
Winson Jianhong Tan, Min Hoe Chew, Angela Renayanti Dharmawan, Manraj Singh, Carol Tien Tau Loi, Choong Leong Tang, Department of Colorectal Surgery, Singapore General Hospital, Singapore 169856, Singapore
Sanchalika Acharyya, Centre for Qualitative Medicine, DUKE NUS Graduate Medical School, Singapore 169857, Singapore
Author contributions: Tan WJ, Chew MH, Dharmawan AR, Singh M, Acharrya S, Loi CTT and Tang CL designed the study; Tan WJ, Dharmawan AR, Singh M and Loi CTT collected data for the study; Tan WJ, Chew MH, Dharmawan AR, Singh M, Acharrya S and Tang CL performed statistical analysis for the study; Tan WJ, Chew MH, Dharmawan AR, Singh M, Acharrya S, Loi CTT and Tang CL drafted the manuscript and were involved in the final approval of the manuscript.
Institutional review board statement: This study was approved by the Singhealth Institutional Review Board.
Informed consent statement: Waiver granted by Institutional Review Board in view of Retrospective nature of study.
Conflict-of-interest statement: There are no conflicts of interest.
Data sharing statement: No additional data are available.
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: Dr. Min Hoe Chew, Consultant, MBBS, M. Med, FRCS, Department of Colorectal Surgery, Singapore General Hospital, 20 College Road, Academia, Singapore 169856, Singapore. chew.min.hoe@sgh.com.sg
Telephone: +65-63214677 Fax: +65-62273787
Received: February 2, 2016
Peer-review started: February 2, 2016
First decision: March 1, 2016
Revised: March 5, 2016
Accepted: March 24, 2016
Article in press: March 25, 2016
Published online: June 27, 2016
Abstract

AIM: To evaluate the long-term clinical and oncological outcomes of laparoscopic rectal resection (LRR) and the impact of conversion in patients with rectal cancer.

METHODS: An analysis was performed on a prospective database of 633 consecutive patients with rectal cancer who underwent surgical resection. Patients were compared in three groups: Open surgery (OP), laparoscopic surgery, and converted laparoscopic surgery. Short-term outcomes, long-term outcomes, and survival analysis were compared.

RESULTS: Among 633 patients studied, 200 patients had successful laparoscopic resections with a conversion rate of 11.1% (25 out of 225). Factors predictive of survival on univariate analysis include the laparoscopic approach (P = 0.016), together with factors such as age, ASA status, stage of disease, tumor grade, presence of perineural invasion and vascular emboli, circumferential resection margin < 2 mm, and postoperative adjuvant chemotherapy. The survival benefit of laparoscopic surgery was no longer significant on multivariate analysis (P = 0.148). Neither 5-year overall survival (70.5% vs 61.8%, P = 0.217) nor 5-year cancer free survival (64.3% vs 66.6%, P = 0.854) were significantly different between the laparoscopic group and the converted group.

CONCLUSION: LRR has equivalent long-term oncologic outcomes when compared to OP. Laparoscopic conversion does not confer a worse prognosis.

Keywords: Rectal cancer, Laparoscopic, Outcomes, Conversion, Prognosis

Core tip: Laparoscopic rectal resection (LRR) remains controversial in view of concerns over its long term oncological outcome and the adverse impact conversion may have on survival. Our retrospective study has demonstrated that LRR has equivalent long-term oncologic outcomes when compared to open surgery. Conversion was also found not to confer a worse prognosis.