Long-term oncologic outcomes of laparoscopic vs open surgery for stages II and III rectal cancer: A retrospective cohort study

Abstract

Aim: To evaluate the 5-year survival after laparoscopic surgery vs open surgery for stages II and III rectal cancer.

Methods: This study enrolled 406 consecutive patients who underwent curative resection for stages II and III rectal cancer between January 2000 and December 2009 [laparoscopic rectal resection (LRR), n = 152; open rectal resection (ORR), n = 254]. Clinical characteristics, operative outcomes, pathological outcomes, postoperative recovery, and 5-year survival outcomes were compared between the two groups.

Results: Most of the clinical characteristics were similar except age (59 years vs 55 years, P = 0.033) between the LRR group and ORR group. The proportion of anterior resection was higher in the LRR group than that in the ORR group (81.6% vs 66.1%, P = 0.001). The LRR group had less estimated blood loss (50 mL vs 200 mL, P < 0.001) and a lower rate of blood transfusion (4.6% vs 11.8%, P = 0.019) compared to the ORR group. The pathological outcomes of the two groups were comparable. The LRR group was associated with faster recovery of bowel function (2.8 d vs 3.7 d, P < 0.001) and shorter postoperative hospital stay (11.7 d vs 13.7 d, P < 0.001). The median follow-up time was 63 mo in the LRR group and 65 mo in the ORR group. As for the survival outcomes, the 5-year local recurrence rate (16.0% vs 16.4%, P = 0.753), 5-year disease-free survival (DFS) rate (63.0% vs 63.1%, P = 0.589), and 5-year overall survival (OS) rate (68.1% vs 63.5%, P = 0.682) were comparable between the LRR group and the ORR group. Stage by stage, there were also no statistical differences between the LRR group and the ORR group in terms of the 5-year local recurrence rate (stage II: 6.3% vs 8.7%, P = 0.623; stage III: 26.4% vs 23.2%, P = 0.747), 5-year DFS rate (stage II: 77.5% vs 77.6%, P = 0.462; stage III: 46.5% vs 50.9%, P = 0.738), and 5-year OS rate (stage II: 81.4% vs 74.3%, P = 0.242; stage III: 53.9% vs 54.1%, P = 0.459).

Conclusion: LRR for stages II and III rectal cancer can yield comparable long-term survival while achieving short-term benefits compared to open surgery.

Keywords: Laparoscopic surgery; Locally advanced rectal cancer; Oncologic outcomes.

Figure 1

Cumulative local recurrence between the LRR and ORR groups. A: 5-year: 16.0% vs 16.4%, P = 0.753; B: 5-year: stage II 6.3% vs 8.7%, P = 0.623; stage III 26.4% vs 23.2%, P = 0.747.

Figure 2

Cumulative disease-free survival between the LRR and ORR groups. A: 5-year: 63.0% vs 63.1%, P = 0.589; B: 5-year: stage II 77.5% vs 77.6%, P = 0.462; stage III 46.5% vs 50.9%, P = 0.738.

Figure 3

Cumulative overall survival between the LRR and ORR groups. A: 5-year: 68.1% vs 63.5%, P = 0.682; B: 5-year: stage II 81.4% vs 74.3%, P = 0.242; stage III 53.9% vs 54.1%, P = 0.459.