Analysis of Early and Long-Term Oncologic Outcomes After Converted Laparoscopic Resection Compared to Primary Open Surgery for Rectal Cancer
Marco Ettore Allaix, Edgar Furnée, Laura Esposito, Massimiliano Mistrangelo, Fabrizio Rebecchi, Alberto Arezzo, Mario Morino, Marco Ettore Allaix, Edgar Furnée, Laura Esposito, Massimiliano Mistrangelo, Fabrizio Rebecchi, Alberto Arezzo, Mario Morino
Abstract
Background: Laparoscopic rectal resection (LRR) for cancer is a challenging procedure, with conversion to open surgery being reported in up to 30% of cases. Since only a few studies with short follow-up have compared converted LRR and open RR (ORR), it is unclear if conversion to open surgery should be prevented by preferring an open approach in those patients with preoperatively known risk factors for conversion. The aim of this study was to compare early postoperative outcomes and long-term survival after completed LRR, converted LRR or ORR for non-metastatic rectal cancer.
Methods: A prospective database of consecutive curative LRRs and ORRs for rectal cancer was reviewed. Patients undergoing LRR who required conversion (CONV group) were compared with those who had primary open rectal surgery (OPEN group) and completed LRR (LAP group). A multivariate analysis was performed to identify predictors of poor survival.
Results: A total of 537 patients were included in the study: 272 in the LAP group, 49 in the CONV group and 216 in the OPEN group. There were no significant differences in perioperative morbidity, mortality and length of hospital stay between the three groups. Five-year overall survival and disease-free survival rates did not significantly differ between LAP, CONV and OPEN patients: 83.9 versus 77.8 versus 81% (P = 0.398) and 74.5 versus 62.9 versus 72.7% (P = 0.145), respectively. Similar 5-year OS and DFS rates were observed between patients who had converted LRR for locally advanced tumor or for non-tumor-related reasons: 81.2 versus 80.8% (P = 0.839) and 62.5 versus 63.7% (P = 0.970), respectively. Poor grade of tumor differentiation, lymphovascular invasion and a lymph node ratio of 0.25 or greater, but not conversion, were independently associated with poorer survival.
Conclusion: Conversion to open surgery does not impair short-term outcomes and does not jeopardize 5-year survival in patients with rectal cancer when compared to primary open surgery.
References
- Br J Surg. 2013 Sep;100(10):1368-75
- World J Surg. 2011 Jan;35(1):178-85
- J Gastrointest Surg. 2015 Feb;19(2):335-43
- Colorectal Dis. 2012 Dec;14(12):1473-8
- Int J Colorectal Dis. 2008 Apr;23(4):409-17
- Ann Surg. 2009 Jul;250(1):54-61
- Lancet. 2005 May 14-20;365(9472):1718-26
- Colorectal Dis. 2015 Jun;17(6):482-90
- Surg Endosc. 2008 Dec;22(12):2631-4
- Surg Endosc. 2014 Jun;28(6):1940-8
- Eur J Surg Oncol. 2009 Dec;35(12):1273-9
- Surg Endosc. 2013 May;27(5):1485-502
- Int J Colorectal Dis. 2015 Sep;30(9):1209-16
- Zentralbl Chir. 2011 Jun;136(3):273-81
- Int J Colorectal Dis. 2010 Aug;25(8):983-8
- Surg Endosc. 2000 Dec;14(12):1114-7
- Br J Surg. 2013 Jan;100(1):75-82
- Surg Endosc. 2013 Dec;27(12):4596-607
- Surg Endosc. 2013 Dec;27(12):4675-83
- Ann Surg. 2009 Jan;249(1):82-6
- J Am Coll Surg. 2009 Mar;208(3):383-9
- Ann Surg Oncol. 2009 May;16(5):1279-86
- Ann Surg. 2010 Apr;251(4):652-8
- Ann Surg Oncol. 2010 Jun;17(6):1471-4
- World J Gastroenterol. 2016 Oct 7;22(37):8304-8313
- N Engl J Med. 2015 Apr 2;372(14):1324-32
- Ann Surg. 2004 Aug;240(2):205-13
- J Gastrointest Surg. 2016 May;20(5):1042-8
- Surg Endosc. 2009 Apr;23(4):839-46
- Surg Endosc. 2009 Nov;23(11):2454-8
- Br J Surg. 2013 Nov;100(12):1641-8
- Surg Endosc. 2005 Jan;19(1):47-54
- Dis Colon Rectum. 2014 Jul;57(7):869-74
- World J Surg. 2015 May;39(5):1240-7
- Surg Endosc. 2006 Jun;20(6):947-51
Source: PubMed