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Surgical Endoscopy
Erschienen in: Surgical Endoscopy 8/2017

08.11.2016

Multicentre propensity score-matched analysis of laparoscopic versus open surgery for T4 rectal cancer

verfasst von: Nicola de’Angelis, Filippo Landi, Giulio Cesare Vitali, Riccardo Memeo, Aleix Martínez-Pérez, Alejandro Solis, Michela Assalino, Francesc Vallribera, Henry Alexis Mercoli, Jacques Marescaux, Didier Mutter, Frédéric Ris, Eloy Espin, Francesco Brunetti

Erschienen in: Surgical Endoscopy | Ausgabe 8/2017

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Abstract

Background

The use of laparoscopy for advanced-stage rectal cancer remains controversial. This study aimed to compare the operative and oncologic outcomes of laparoscopic (LAR) versus open anterior rectal resection (OAR) for patients with pT4 rectal cancer.

Methods

This is a multicenter propensity score matching (PSM) study of patients undergoing elective curative-intent LAR or OAR for pT4 rectal cancer (TNM stage II/III/IV) between 2005 and 2015.

Results

In total, 137 patients were included in the analysis. After PSM, demographic, clinical and tumor characteristics were similar between the 52 LAR and the 52 OAR patients. Overall, 52 tumors were located in the high rectum, 25 in the mid-rectum and 27 in the low rectum. Multivisceral resection was performed in 26.9% of LAR and 30.8% of OAR patients (p = 0.829). Conversion was required in 11 LAR patients (21.2%). The LAR group showed significantly shorter time to flatus (3.13 vs. 4.97 days, p = 0.001), time to regular diet (3.59 vs. 6.36 days, p < 0.0001) and hospital stay (15.49 vs. 17.96 days, p = 0.002) compared to the OAR group. The 90-day morbidity and mortality were not different between groups. In the majority of patients (85.6%), R0 resection was achieved. A complete mesorectal excision was obtained in 82.7% of LAR and 78.8% of OAR patients (p = 0.855). The 1-, 2- and 3-year overall survival rates were, respectively, 95.6, 73.8 and 66.7% for the LAR group and 86.7, 66.9 and 64.1% for the OAR group (p = 0.219). The presence of synchronous metastases (hazard ratio 2.26), R1 resection (HR 2.71) and lymph node involvement (HR 2.24) were significant predictors of overall survival.

Conclusion

The present study suggests that LAR for pT4 rectal cancer can achieve good pathologic and oncologic outcomes similar to open surgery despite the risk of conversion. Moreover, laparoscopy offers the benefits of a faster recovery and a shorter hospital stay.
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Metadaten
Titel
Multicentre propensity score-matched analysis of laparoscopic versus open surgery for T4 rectal cancer
verfasst von
Nicola de’Angelis
Filippo Landi
Giulio Cesare Vitali
Riccardo Memeo
Aleix Martínez-Pérez
Alejandro Solis
Michela Assalino
Francesc Vallribera
Henry Alexis Mercoli
Jacques Marescaux
Didier Mutter
Frédéric Ris
Eloy Espin
Francesco Brunetti
Publikationsdatum
08.11.2016
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 8/2017
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-5332-9

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