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Laparoscopic Surgery for Rectal Carcinoma – Long-Term Outcomes


Authors: L. Martínek ;  J. Dostalík;  I. Guňka;  P. Guňková;  P. Vávra
Authors place of work: Chirurgická klinika FN Ostrava, přednosta doc. MUDr. Jan Dostalík, CSc.
Published in the journal: Rozhl. Chir., 2009, roč. 88, č. 11, s. 675-680.
Category: Monothematic special - Original

Summary

Introduction:
Laparoscopic surgery for rectal cancer is still debated. The aim of this study was to compare long-term results for patients undergoing laparoscopic or open surgery for rectal cancer.

Material and methods:
The study included a group of 196 patients who underwent elective operation for rectal cancer using laparoscopic (103 patients) or open technique (93 patients) from 1 January 2001 to 31 December 2006. It was a unicentric, comparative, non-randomized clinical study. Monitored data included characteristics of patients, surgery data, tumour characteristics and long-term outcomes. The main objective was the comparison of long-term outcomes. Three- and five-year overall survival, Kaplan-Meier curves of cumulative survival and recurrence rate were compared. P-value < 0.05 was interpreted as statistically significant result.

Results:
Long-term results were obtained from, 180 patients, 8 patients of the laparoscopic group and 8 patients of the open surgery were lost. Although the study was not a randomised one, both groups were comparable in terms of sex, age, body mass index, tumour characteristics, types of procedure, neoadjuvancy and proportion of curative an palliative surgeries. Total three-year survival after open or laparoscopic procedure for all patients was 57% and 62% respectively, curative operations 71% and 79% respectively, stage I 100% and 90% respectively, stage II 89% and 80% respectively, stage III 54% vs. 75%, stage IV 8% vs. 15%. Total five-year survival after open or laparoscopic technique for all patients was 46% and 55% respectively, curative operations 60% and 75% respectively, stage I 88% and 86% respectively, stage II 87% and 83% respectively, stage III 41% vs. 72%, stage IV 0% in both groups. Except for significantly better five-year survival in group of laparoscopic technique and stage III (p = 0.0381), we reported no difference in long-term survival. The same results, i.e. no difference in long-term survival, with better outcomes in group of patients with laparoscopy and stage III (p = 0.01677) were obtained by analysis of cumulative survival curves. We proved no difference in incidence of local recurrence, distant recurrence and generalisation of the disease.

Conclusion:
In this nonrandomized single centre study the long-term oncologic outcomes were not significantly different in group of patients undergoing laparoscopic surgery for rectal cancer. The probability of survival in the laparoscopic group for stage III carcinoma was conversely significantly better.

Key words:
laparoscopy – rectal cancer – oncological outcomes


Zdroje

1. Abraham, N. S., Young, J. M., Solomon, M. J. Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br. J. Surg., 2004; 91: 1111–1124.

2. Schwenk, W., Haase, O., Neudecker, J., Müller, J. M. Short term benefits for laparoscopic colorectal resection. Cochrane database of systematic reviews, 2005; Issue 2.: art. No. CD003145.

3. Fleshman, J., Sargent, D. J., Green, E., et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST study group trial. Ann. Surg., 2007; 246: 655–662.

4. Jackson, T. D., Kaplan, G. G., Arena, G., et al. Laparoscopic versus open resection for colorectal cancer: a metaanalysis of oncologic outcomes. J. Am. Coll. Surg., 2007; 204: 439–446.

5. Bonjer, H. J., Hop, W. C. J., Nelson, H., et al. Laparoscopically assisted vs open colectomy for colon cancer. Arch. Surg., 2007; 142: 298–303.

6. Kitano, S., Kitajima, M., Konishi, F., et al. A multicenter study on laparoscopic surgery for colorectal cancer in Japan. Surg. Endos., 2006; 20: 1348–1352.

7. Aziz, O., Constantinides, V., Tekkis, P. P., et al. Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann. Surg. Oncol., 2006; 13: 413–424.

8. Anderson, C., Uman, G., Pigazzi, A. Oncologic outcomes of laparoscopic surgery for rectal cancer: a systematic review and meta-analysis of the literature. Eur. J. Surg. Oncol., 2008; 34: 1135–1142.

9. Jayne, D. G., Guillou, P. J., Thorpe, H., Quirke, P., Copeland, J., Smith, A. H., Heath, M., Brown, J. M. Randomised trial of Laparoscopic-assisted rsection of colorectal carcinoma: 3-year results of the UK MRC CLASICC trial group. J. Clin. Oncol., 2007; 25: 3061–3068.

10. Morino, M., Allaix, M. E., Giraudo, G., Corno, F., Garrone, C. Laparoscopic versus open surgery for extraperitoneal rectal cancer: a prospective comparative study. Surg. Endosc., 2005; 19: 1460–1467.

11. Law, L. W., Lee, Y. M., Choi, H. K., Seto, Ch. L., Ho, J. W. C. Laparoscopic and open anterior resection for upper and mid rectal cancer: an evaluation of outcomes. Dis. Colon Rectum, 2006; 49: 1108–1115.

12. Feliciotti, F., Guerrieri, M., Paganini, A. K., De Sanctis, A., Campagnacci, R., Perretta, S., D‘Ambrosio, G., Lezoche, G., Lezoche, E. Long-term results of laparoscopic vs open resections for rectal cancer for 124 unselected patiens. Surg. Endosc., 2003; 17: 1530–1535.

13. Bretagnol, F., Lelong, B., Laurent, C., Moutardier, V., Rullier, A., Monges, G., Delpero, J. R., Rullier, E. The oncological safety of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma. Surg. Endosc., 2005; 19: 892–896.

14. Schwandner, O., Schiedeck, T. H. K., Killaitis, C., Bruch, H. P. A case-control-study comparing laparoscopic versus open surgery for rectosigmoidal and rectal cancer. Int. J. Colorectal. Dis., 1999; 14: 158–163.

15. Ng, S. S., Leung, K. L., Lee, J. F., Yiu, R. Y., Li, J. C., Teoh, A. Y., Leung, W. W. Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer.: a prospective randomized study. Ann. Surg. Oncol., 15; 2008: 2418–2425.

16. Agha, A., Fürst, A., Hierl, J., Iesalnieks, I., Glockzin, G., Anthuber, M., Jauch, K. W., Schlitt, H. J. Laparoscopic surgery for rectal cancer: oncological results and clinical outcome of 225 patients. Surg. Endosc., 2008; 22: 2229–2237.

17. Bärlehner, E., Benhidjeb, T., Anders, S., Schicke, B. Laparoscopic resection for rectal cancer. Surg. Endosc., 2005;19: 757–766.

18. Leroy, J., Jamali, F., Forbes, L., Smith, M., Rubino, F., Mutter, D., Marescaux, J. Laparoscopic total mesorectal excision (TME) for rectal cancer surgery. Long-term outcomes. Surg. Endosc., 2004; 18: 281–289.

19. Dulucq, J. L., Wintringer, P., Stabalini, C., Mahajna, A. Laparoscopic rectal resection with anal sphincter preservation for rectal cancer. Surg. Endosc., 2005; 19: 1468–1474.

20. Bianchi, P. P., Rosati, R., Bona, S., Rottoli, M., Elmore, U., Ceriani, Ch., Malesci, A., Montorsi, M. Laparoscopic surgery in rectal cancer: a prospective analysis of patient survival and outcomes. Dis. Colon Rectum, 2007; 50: 2047–2053.

21. Braga, M., Frasson, M., Vignali, A., Zuliani, W., Civelli, V., Di Carlo, V. Laparoscopic versus open colectomy in cancer patiens: long-term complications, quality of life, and survival. Dis. Colon Rectum, 2005; 48: 2217–2223.

22. Fleshman, J. W., Wexner, S., Anvari, M., et al. Laparoscopic vs. open abdominoperineal resection for cancer. Dis. Colon Rectum, 1999; 42: 930–939.

Štítky
Surgery Orthopaedics Trauma surgery

Článok vyšiel v časopise

Perspectives in Surgery

Číslo 11

2009 Číslo 11
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