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Surgical Endoscopy
Published in: Surgical Endoscopy 6/2014

01-06-2014

Laparoscopic and converted approaches to rectal cancer resection have superior long-term outcomes: a comparative study by operative approach

Authors: Deborah S. Keller, Zhamak Khorgami, Brian Swendseid, Bradley J. Champagne, Harry L. Reynolds Jr., Sharon L. Stein, Conor P. Delaney

Published in: Surgical Endoscopy | Issue 6/2014

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Abstract

Background and objectives

The goal of this study was to evaluate outcomes for rectal cancer resection by operative approach. Our hypothesis is that laparoscopic (LAP) and LAP converted to open (OPEN) rectal cancer resections have excellent patient and oncologic outcomes.

Methods

Review of a prospective database identified curative rectal cancer resections. Patients were stratified by operative approach: LAP, OPEN, or CONVERTED. Oncologic and clinical outcomes data was examined for each operative approach.

Results

Overall, 294 patients were analyzed—116 LAP (39.5 %), 153 OPEN (52.0 %), and 25 (8.5 %) CONVERTED. Groups were comparable in demographics. Mean distal margin, circumferential resection margin, and lymph nodes harvested were comparable. The median length of stay was 4 days (range 1–20) LAP, 6 days (range 3–13) CONVERTED, and 8 days (range 1–35) OPEN (p < 0.01). More OPEN had postoperative complications (p < 0.01)—complication rates were 43.8 % OPEN, 32.0 % CONVERTED, and 21.5 % LAP. Unplanned readmissions and reoperations were similar (21.6 % OPEN, 16.0 % CONVERTED, 12.1 % LAP). Overall 3-year disease-free survival (DFS) was 98.3 %, and local recurrence rate was 2.0 %. By approach, DFS was 100 % CONVERTED, 93.1 % LAP, and 87.6 % OPEN (p = 0.31). Overall survival (OS) was 100 % CONVERTED, 99.1 % LAP, and 97.4 %. OPEN. Local recurrence was 0 % CONVERTED, 2 % OPEN, and 2.6 % LAP. 3-year DFS for LAP and CONVERTED was superior to OPEN (p = 0.05), with comparable local recurrence (p = 0.07) and OS rates (0.43).

Conclusions

LAP and converted procedures have comparable or superior clinical and oncologic outcomes. More procedures should be approached through a LAP approach. If the procedure cannot be completed laparoscopically, outcomes are not compromised for converted patients.
Literature
1.
Bilimoria KY, Bentrem DJ, Merkow RP et al (2008) Laparoscopic-assisted vs. open colectomy for cancer: comparison of short-term outcomes from 121 hospitals. J Gastrointest Surg 12:2001–2009PubMedCrossRef
2.
Fox J, Gross CP, Longo W, Reddy V (2012) Laparoscopic colectomy for the treatment of cancer has been widely adopted in the United States. Dis Colon Rectum 55:501–508PubMedCrossRef
3.
Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRef
4.
Delaney CP, Kiran RP, Senagore AJ, Brady K, Fazio VW (2003) Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery. Ann Surg 238:67–72PubMedCentralPubMed
5.
Delaney CP, Marcello PW, Sonoda T, Wise P, Bauer J, Techner L (2010) Gastrointestinal recovery after laparoscopic colectomy: results of a prospective, observational, multicenter study. Surg Endosc 24:653–661PubMedCrossRef
6.
Bonjer HJ, Hop WC, Nelson H et al (2007) Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg 142:298–303PubMedCrossRef
7.
Lacy AM, Garcia-Valdecasas JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229PubMedCrossRef
8.
Lacy AM, Delgado S, Castells A et al (2008) The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg 248:1–7PubMedCrossRef
9.
Schwenk W, Bohm B, Muller JM (1998) Influence of laparoscopic or conventional colorectal resection on postoperative quality of life (in German). Zentralbl Chir 123:483–490PubMed
10.
Schwenk W, Haase O, Neudecker J, Muller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 3:CD003145PubMed
11.
Tjandra JJ, Chan MK (2006) Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer. Colorectal Dis 8:375–388PubMedCrossRef
12.
Veldkamp R, Kuhry E, Hop WC et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484PubMedCrossRef
13.
Wind J, Polle SW, Fung Kon Jin PH et al (2006) Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 93:800–809PubMedCrossRef
14.
Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726PubMedCrossRef
15.
Row D, Weiser MR (2010) An update on laparoscopic resection for rectal cancer. Cancer Control 17:16–24PubMed
16.
Baik SH, Gincherman M, Mutch MG, Birnbaum EH, Fleshman JW (2011) Laparoscopic vs open resection for patients with rectal cancer: comparison of perioperative outcomes and long-term survival. Dis Colon Rectum 54:6–14PubMedCrossRef
17.
18.
Law WL, Poon JT, Fan JK, Lo SH (2009) Comparison of outcome of open and laparoscopic resection for stage II and stage III rectal cancer. Ann Surg Oncol 16:1488–1493PubMedCrossRef
19.
Rullier E, Laurent C, Bretagnol F, Rullier A, Vendrely V, Zerbib F (2005) Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg 241:465–469PubMedCentralPubMedCrossRef
20.
Anderson C, Uman G, Pigazzi A (2008) Oncologic outcomes of laparoscopic surgery for rectal cancer: a systematic review and meta-analysis of the literature. Eur J Surg Oncol 34:1135–1142PubMedCrossRef
21.
Aziz O, Constantinides V, Tekkis PP et al (2006) Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol 13:413–424PubMedCrossRef
22.
Gao F, Cao YF, Chen LS (2006) Meta-analysis of short-term outcomes after laparoscopic resection for rectal cancer. Int J Colorectal Dis 21:652–656PubMedCrossRef
23.
Huang MJ, Liang JL, Wang H, Kang L, Deng YH, Wang JP (2011) Laparoscopic-assisted versus open surgery for rectal cancer: a meta-analysis of randomized controlled trials on oncologic adequacy of resection and long-term oncologic outcomes. Int J Colorectal Dis 26:415–421PubMedCrossRef
24.
Kang SB, Park JW, Jeong SY et al (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11:637–645PubMedCrossRef
25.
Laurent C, Leblanc F, Gineste C, Saric J, Rullier E (2007) Laparoscopic approach in surgical treatment of rectal cancer. Br J Surg 94:1555–1561PubMedCrossRef
26.
Laurent C, Leblanc F, Wutrich P, Scheffler M, Rullier E (2009) Laparoscopic versus open surgery for rectal cancer: long-term oncologic results. Ann Surg 250:54–61PubMedCrossRef
27.
Lelong B, Bege T, Esterni B et al (2007) Short-term outcome after laparoscopic or open restorative mesorectal excision for rectal cancer: a comparative cohort study. Dis Colon Rectum 50:176–183PubMedCrossRef
28.
Lujan J, Valero G, Hernandez Q, Sanchez A, Frutos MD, Parrilla P (2009) Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg 96:982–989PubMedCrossRef
29.
Ng SS, Leung KL, Lee JF et al (2008) Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial. Ann Surg Oncol 15:2418–2425PubMedCrossRef
30.
Ng SS, Leung KL, Lee JF, Yiu RY, Li JC, Hon SS (2009) Long-term morbidity and oncologic outcomes of laparoscopic-assisted anterior resection for upper rectal cancer: 10-year results of a prospective, randomized trial. Dis Colon Rectum 52:558–566PubMedCrossRef
31.
Ohtani H, Tamamori Y, Azuma T et al (2011) A meta-analysis of the short- and long-term results of randomized controlled trials that compared laparoscopy-assisted and conventional open surgery for rectal cancer. J Gastrointest Surg 15:1375–1385PubMedCrossRef
32.
Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97:1638–1645PubMedCrossRef
33.
van der Pas MH, Haglind E, Cuesta MA et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218PubMedCrossRef
34.
Society of American Gastrointestinal and Endoscopic Surgeons (2012) Guidelines for laparoscopic resection of curable colon and rectal cancer. Society of American Gastrointestinal and Endoscopic Surgeons, Los Angeles
35.
Gervaz P, Pikarsky A, Utech M et al (2001) Converted laparoscopic colorectal surgery. Surg Endosc 15:827–832PubMedCrossRef
36.
Lezoche E, Feliciotti F, Paganini AM et al (2002) Results of laparoscopic versus open resections for non-early rectal cancer in patients with a minimum follow-up of 4 years. Hepatogastroenterology 49:1185–1190PubMed
37.
Feliciotti F, Guerrieri M, Paganini AM et al (2003) Long-term results of laparoscopic versus open resections for rectal cancer for 124 unselected patients. Surg Endosc 17:1530–1535PubMedCrossRef
38.
Leroy J, Jamali F, Forbes L et al (2004) Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 18:281–289PubMedCrossRef
39.
Barlehner E, Benhidjeb T, Anders S, Schicke B (2005) Laparoscopic resection for rectal cancer: outcomes in 194 patients and review of the literature. Surg Endosc 19:757–766PubMedCrossRef
40.
Zheng MH, Feng B, Hu CY et al (2010) Long-term outcome of laparoscopic total mesorectal excision for middle and low rectal cancer. Minim Invasive Ther Allied Technol 19:329–339PubMedCrossRef
41.
Boutros M, Hippalgaonkar N, Silva E, Allende D, Wexner SD, Berho M (2013) Laparoscopic resection of rectal cancer results in higher lymph node yield and better short-term outcomes than open surgery: a large single-center comparative study. Dis Colon Rectum 56:679–688PubMedCrossRef
42.
Moloo H, Mamazza J, Poulin EC et al (2004) Laparoscopic resections for colorectal cancer: does conversion survival? Surg Endosc 18:732–735PubMedCrossRef
43.
Chan AC, Poon JT, Fan JK, Lo SH, Law WL (2008) Impact of conversion on the long-term outcome in laparoscopic resection of colorectal cancer. Surg Endosc 22:2625–2630PubMedCrossRef
44.
Casillas S, Delaney CP, Senagore AJ, Brady K, Fazio VW (2004) Does conversion of a laparoscopic colectomy adversely affect patient outcome? Dis Colon Rectum 47:1680–1685PubMedCrossRef
45.
Rottoli M, Stocchi L, Geisler DP, Kiran RP (2012) Laparoscopic colorectal resection for cancer: effects of conversion on long-term oncologic outcomes. Surg Endosc 26:1971–1976PubMedCrossRef
46.
Rottoli M, Bona S, Rosati R et al (2009) Laparoscopic rectal resection for cancer: effects of conversion on short-term outcome and survival. Ann Surg Oncol 16:1279–1286PubMedCrossRef
47.
Delaney CP (2008) Outcome of discharge within 24–72 h after laparoscopic colorectal surgery. Dis Colon Rectum 51:181–185PubMedCrossRef
48.
Delaney CP, Brady K, Woconish D, Parmar SP, Champagne BJ (2012) Towards optimizing perioperative colorectal care: outcomes for 1,000 consecutive laparoscopic colon procedures using enhanced recovery pathways. Am J Surg 203:353–355 discussion 355-6PubMedCrossRef
49.
Lindsetmo RO, Champagne B, Delaney CP (2009) Laparoscopic rectal resections and fast-track surgery: what can be expected? Am J Surg 197:408–412PubMedCrossRef
50.
Senagore AJ, Delaney CP (2006) A critical analysis of laparoscopic colectomy at a single institution: lessons learned after 1000 cases. Am J Surg 191:377–380PubMedCrossRef
Metadata
Title
Laparoscopic and converted approaches to rectal cancer resection have superior long-term outcomes: a comparative study by operative approach
Authors
Deborah S. Keller
Zhamak Khorgami
Brian Swendseid
Bradley J. Champagne
Harry L. Reynolds Jr.
Sharon L. Stein
Conor P. Delaney
Publication date
01-06-2014
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 6/2014
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3419-8

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