. 2021 Apr;23(4):843-852.

doi: 10.1111/codi.15464. Epub 2020 Dec 15.

Does oncological outcome differ between restorative and nonrestorative low anterior resection in patients with primary rectal cancer?

Sapho X Roodbeen¹, Robin D Blok^{1

2}, Wernard A Borstlap¹, Willem A Bemelman¹, Roel Hompes¹, Pieter J Tanis¹; Dutch Snapshot Research Group

Collaborators, Affiliations

Collaborators

Dutch Snapshot Research Group:
Agj Aalbers, Y Acherman, G D Algie, B Alting von Geusau, F Amelung, T S Aukema, I S Bakker, S A Bartels, S Basha, Ajnm Bastiaansen, E Belgers, W Bleeker, J Blok, Rji Bosker, J W Bosmans, M C Boute, N D Bouvy, H Bouwman, A Brandt-Kerkhof, D J Brinkman, S Bruin, Erj Bruns, Jpm Burbach, Jwa Burger, C J Buskens, S Clermonts, Pplo Coene, C Compaan, Ecj Consten, T Darbyshire, Sml de Mik, Ejr de Graaf, I de Groot, R J de Vos Tot Nederveen Cappel, Jhw de Wilt, J van der Wolde, F C den Boer, Jwt Dekker, A Demirkiran, M Derkx-Hendriksen, F R Dijkstra, P van Duijvendijk, M S Dunker, Q E Eijsbouts, H Fabry, F Ferenschild, J W Foppen, Ejb Furnee, M F Gerhards, P van Gerven, Jah Gooszen, J A Govaert, Wmu Van Grevenstein, R Haen, J J Harlaar, E van der Harst, K Havenga, J Heemskerk, J F Heeren, B Heijnen, P Heres, C Hoff, W Hogendoorn, P Hoogland, A Huijbers, P Janssen, A C Jongen, F H Jonker, E G Karthaus, A Keijzer, Jma Ketel, J Klaase, Fwh Kloppenberg, M E Kool, R Kortekaas, P M Kruyt, J T Kuiper, B Lamme, J F Lange, T Lettinga, D J Lips, F Logeman, M F Lutke Holzik, E Madsen, A Mamound, C C Marres, I Masselink, M Meerdink, A G Menon, J S Mieog, D Mierlo, G D Musters, Gap Nieuwenhuijzen, P A Neijenhuis, J Nonner, M Oostdijk, S J Oosterling, Pmp Paul, Kcmj Peeters, Ita Pereboom, F Polat, P Poortman, M Raber, Bmm Reiber, R J Renger, C C van Rossem, H J Rutten, A Rutten, R Schaapman, M Scheer, L Schoonderwoerd, N Schouten, A M Schreuder, W H Schreurs, G A Simkens, G D Slooter, Hce Sluijmer, N Smakman, R Smeenk, H S Snijders, Dja Sonneveld, B Spaansen, E J Spillenaar Bilgen, E Steller, W H Steup, C Steur, E Stortelder, J Straatman, H A Swank, C Sietses, H A Groen, H G Ten Hoeve, W W Ter Riele, I M Thorensen, B Tip-Pluijm, B R Toorenvliet, L Tseng, J B Tuynman, J van Bastelaar, S C van Beek, Awh van de Ven, Maj van de Weijer, C van den Berg, I van den Bosch, Jdw van der Bilt, S J van der Hagen, R van der Hul, G van der Schelling, A van der Spek, N van der Wielen, E van Duyn, C van Eekelen, J A van Essen, K van Gangelt, Aaw van Geloven, C van Kessel, Y T van Loon, A van Rijswijk, S J van Rooijen, T van Sprundel, L van Steensel, W F van Tets, H L van Westreenen, S C Veltkamp, T Verhaak, P M Verheijen, L Versluis-Ossenwaarde, S Vijfhuize, W J Vles, S C Voeten, F J Vogelaar, W W Vrijland, E Westerduin, M E Westerterp, M Wetzel, K P Wevers, B Wiering, Cdm Witjes, M W Wouters, Stk Yauw, E S van der Zaag, E C Zeestraten, Dde Zimmerman, T Zwiete

Affiliations

¹ Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands.
² LEXOR, Center for Experimental and Molecular Medicine, Oncode Institute, Cancer Center Amsterdam, Amsterdam UMC (AMC), University of Amsterdam, Amsterdam, the Netherlands.

PMID: 33245846
PMCID: PMC8247354
DOI: 10.1111/codi.15464

Does oncological outcome differ between restorative and nonrestorative low anterior resection in patients with primary rectal cancer?

Sapho X Roodbeen et al. Colorectal Dis. 2021 Apr.

. 2021 Apr;23(4):843-852.

doi: 10.1111/codi.15464. Epub 2020 Dec 15.

Authors

Sapho X Roodbeen¹, Robin D Blok^{1

2}, Wernard A Borstlap¹, Willem A Bemelman¹, Roel Hompes¹, Pieter J Tanis¹; Dutch Snapshot Research Group

Collaborators

Dutch Snapshot Research Group:
Agj Aalbers, Y Acherman, G D Algie, B Alting von Geusau, F Amelung, T S Aukema, I S Bakker, S A Bartels, S Basha, Ajnm Bastiaansen, E Belgers, W Bleeker, J Blok, Rji Bosker, J W Bosmans, M C Boute, N D Bouvy, H Bouwman, A Brandt-Kerkhof, D J Brinkman, S Bruin, Erj Bruns, Jpm Burbach, Jwa Burger, C J Buskens, S Clermonts, Pplo Coene, C Compaan, Ecj Consten, T Darbyshire, Sml de Mik, Ejr de Graaf, I de Groot, R J de Vos Tot Nederveen Cappel, Jhw de Wilt, J van der Wolde, F C den Boer, Jwt Dekker, A Demirkiran, M Derkx-Hendriksen, F R Dijkstra, P van Duijvendijk, M S Dunker, Q E Eijsbouts, H Fabry, F Ferenschild, J W Foppen, Ejb Furnee, M F Gerhards, P van Gerven, Jah Gooszen, J A Govaert, Wmu Van Grevenstein, R Haen, J J Harlaar, E van der Harst, K Havenga, J Heemskerk, J F Heeren, B Heijnen, P Heres, C Hoff, W Hogendoorn, P Hoogland, A Huijbers, P Janssen, A C Jongen, F H Jonker, E G Karthaus, A Keijzer, Jma Ketel, J Klaase, Fwh Kloppenberg, M E Kool, R Kortekaas, P M Kruyt, J T Kuiper, B Lamme, J F Lange, T Lettinga, D J Lips, F Logeman, M F Lutke Holzik, E Madsen, A Mamound, C C Marres, I Masselink, M Meerdink, A G Menon, J S Mieog, D Mierlo, G D Musters, Gap Nieuwenhuijzen, P A Neijenhuis, J Nonner, M Oostdijk, S J Oosterling, Pmp Paul, Kcmj Peeters, Ita Pereboom, F Polat, P Poortman, M Raber, Bmm Reiber, R J Renger, C C van Rossem, H J Rutten, A Rutten, R Schaapman, M Scheer, L Schoonderwoerd, N Schouten, A M Schreuder, W H Schreurs, G A Simkens, G D Slooter, Hce Sluijmer, N Smakman, R Smeenk, H S Snijders, Dja Sonneveld, B Spaansen, E J Spillenaar Bilgen, E Steller, W H Steup, C Steur, E Stortelder, J Straatman, H A Swank, C Sietses, H A Groen, H G Ten Hoeve, W W Ter Riele, I M Thorensen, B Tip-Pluijm, B R Toorenvliet, L Tseng, J B Tuynman, J van Bastelaar, S C van Beek, Awh van de Ven, Maj van de Weijer, C van den Berg, I van den Bosch, Jdw van der Bilt, S J van der Hagen, R van der Hul, G van der Schelling, A van der Spek, N van der Wielen, E van Duyn, C van Eekelen, J A van Essen, K van Gangelt, Aaw van Geloven, C van Kessel, Y T van Loon, A van Rijswijk, S J van Rooijen, T van Sprundel, L van Steensel, W F van Tets, H L van Westreenen, S C Veltkamp, T Verhaak, P M Verheijen, L Versluis-Ossenwaarde, S Vijfhuize, W J Vles, S C Voeten, F J Vogelaar, W W Vrijland, E Westerduin, M E Westerterp, M Wetzel, K P Wevers, B Wiering, Cdm Witjes, M W Wouters, Stk Yauw, E S van der Zaag, E C Zeestraten, Dde Zimmerman, T Zwiete

Affiliations

¹ Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands.
² LEXOR, Center for Experimental and Molecular Medicine, Oncode Institute, Cancer Center Amsterdam, Amsterdam UMC (AMC), University of Amsterdam, Amsterdam, the Netherlands.

PMID: 33245846
PMCID: PMC8247354
DOI: 10.1111/codi.15464

Abstract

Aim: Nonrestorative low anterior resection (n-rLAR) (also known as low Hartmann's) is performed for rectal cancer when a poor functional outcome is anticipated or there have been problems when constructing the anastomosis. Compared with restorative LAR (rLAR), little oncological outcome data are available for n-rLAR. The aim of this study was to compare oncological outcomes between rLAR and n-rLAR for primary rectal cancer.

Method: This was a nationwide cross-sectional comparative study including all elective sphincter-saving LAR procedures for nonmetastatic primary rectal cancer performed in 2011 in 71 Dutch hospitals. Oncological outcomes of patients undergoing rLAR and n-rLAR were collected in 2015; the data were evaluated using Kaplan-Meier survival analysis and the results compared using log-rank testing. Uni- and multivariable Cox regression analysis was used to evaluate the association between the type of LAR and oncological outcome measures.

Results: A total of 1197 patients were analysed, of whom 892 (75%) underwent rLAR and 305 (25%) underwent n-rLAR. The 3-year local recurrence (LR) rate was 3% after rLAR and 8% after n-rLAR (P < 0.001). The 3-year disease-free survival and overall survival rates were 77% (rLAR) vs 62% (n-rLAR) (P < 0.001) and 90% (rLAR) vs 75% (n-rLAR) (P < 0.001), respectively. In multivariable Cox analysis, n-rLAR was independently associated with a higher risk of LR (OR = 2.95) and worse overall survival (OR = 1.72).

Conclusion: This nationwide study revealed that n-rLAR for rectal cancer was associated with poorer oncological outcome than r-LAR. This is probably a noncausal relationship, and might reflect technical difficulties during low pelvic dissection in a subset of those patients, with oncological implications.

Keywords: local recurrence; low anterior resection; oncological outcome; rectal surgery.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

**Figure 1**
(A) Kaplan‐Meier survival curves of 3‐year local recurrence‐free (A) and 3‐year overall survival (B) proportion of the totale groups. n‐rLAR, nonrestorative low anterior resection; rLAR, restorative low anterior resection

See this image and copyright information in PMC

Comment in

Nonrestorative low anterior resection portends increased local recurrences - results from the Dutch snapshot research group.
Kazi MK, Patel S, Sukumar V, Saklani AP. Kazi MK, et al. Colorectal Dis. 2021 May;23(5):1270-1271. doi: 10.1111/codi.15580. Epub 2021 Mar 4. Colorectal Dis. 2021. PMID: 33567118 No abstract available.
Reply to Kazi et al.
Roodbeen SX, Blok RD, Borstlap WA, Bemelman WA, Hompes R, Tanis PJ. Roodbeen SX, et al. Colorectal Dis. 2021 May;23(5):1271-1272. doi: 10.1111/codi.15579. Epub 2021 Mar 2. Colorectal Dis. 2021. PMID: 33567133 No abstract available.

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Does oncological outcome differ between restorative and nonrestorative low anterior resection in patients with primary rectal cancer?

Collaborators

Affiliations

Does oncological outcome differ between restorative and nonrestorative low anterior resection in patients with primary rectal cancer?

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

MeSH terms

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