Long-term survival outcomes following laparoscopic surgery for clinical stage 0/I rectal carcinoma

Masaaki Ito, Seiichiro Yamamoto, Junji Okuda, Shoichi Fujii, Shigeki Yamaguchi, Koki Otsuka, Kenichi Yoshimura, Masahiko Watanabe, Japan Society of Laparoscopic Colorectal Surgery, Masaaki Ito, Seiichiro Yamamoto, Junji Okuda, Shoichi Fujii, Shigeki Yamaguchi, Koki Otsuka, Kenichi Yoshimura, Masahiko Watanabe, Japan Society of Laparoscopic Colorectal Surgery

Abstract

Aim: To clarify and evaluate the long-term outcomes of laparoscopic surgery for clinical stage 0/I rectal carcinoma patients.

Methods: This single-arm phase II trial involved accredited surgeons from 43 Japanese institutions. Patients were registered preoperatively. The planned sample size was 490. The primary endpoint was overall survival, and long-term outcomes were evaluated.

Results: A total of 495 patients were registered between February 2008 and August 2010. Eight patients (1.6%) required conversion to open surgery. Sphincter-preserving procedures were performed in 477 (97%) patients. Positive radial resection margin was found in two (0.4%) patients. Of 490 patients, 22, 314, 38, 115, and one patient had final pathological stages (p-stage) 0, I, II, III, and IV, respectively. Pathologically, 31.4% (154/490) of the patients did not have p-stage 0/I. The 5-year overall survival (OS) rates in p-stages 0, I, II, and III were 100%, 98%, 97%, and 94%, respectively. The 5-year OS of all patients at 96.6% (95% CI 94.6-97.9) was significantly better than the expected 5-year OS of 81.1% (P < .0001). The 5-year relapse-free survival in p-stages 0, I, II, and III were 100%, 93%, 81%, and 79%, respectively. The 5-year relapse-free survival of all patients was 90.1%. Fifty patients (10.2%) had recurrence; lung recurrence was found in 22 patients, local recurrence in 14, liver in seven, distant lymph node in nine, and bone in three.

Conclusions: Laparoscopic surgery for clinical stage 0/I rectal carcinoma has feasible long-term outcomes. (ClinicalTrials.gov No.NCT00635466.).

Keywords: clinical stage I; clinical trial; laparoscopy; long‐term outcome; rectal cancer.

Conflict of interest statement

Conflict of Interest: The authors declare no conflicts of interest.

© 2020 The Authors. Annals of Gastroenterological Surgery published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Gastroenterological Surgery.

Figures

FIGURE 1
FIGURE 1
(A) Overall survival. (B) Disease‐free survival
FIGURE 2
FIGURE 2
(A) Overall survival of laparoscopic surgery by pathological stages. (B) Relapse‐free survival of laparoscopic surgery by pathological stages

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