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10-Year Oncologic Outcomes After Laparoscopic or Open Total Mesorectal Excision for Rectal Cancer

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Abstract

Background

Only few studies have compared laparoscopic total mesorectal excision (LTME) and open total mesorectal excision (OTME) for rectal cancer with follow-up longer than 5 years. The aim of this study was to compare 10-year oncologic outcomes after LTME and OTME for nonmetastatic rectal cancer.

Methods

We conducted a retrospective analysis of a prospective database of rectal cancer patients undergoing LTME or OTME. Statistical analyses were performed on an ‘‘intention-to-treat’’ basis and by actual treatment. Overall survival (OS) and disease-free survival (DFS) were compared by using the Kaplan–Meier method. A multivariable analysis was performed to identify predictors of poor survival.

Results

Between April 1994 and August 2005, a total of 153 LTME patients and 154 OTME patients were included. Similarly, 10-year OS and DFS after LTME and OTME were observed: 76.8 versus 70.6 % (P = 0.138) and 69.1 versus 67.6 % (P = 0.508), respectively. Conversion to OTME did not adversely affect OS and DFS. Stage-by-stage comparison showed no significant differences between LTME and OTME. No significant differences were observed in local recurrence rates after LTME and OTME (6.5 vs. 7.8 %, P = 0.837). Median time until local recurrence was 24.5 (range, 12–56) months after LTME and 22 (6–64) months after OTME (P = 0.777). Poor tumor differentiation, lymphovascular invasion, and a lymph node ratio of 0.25 or more were the independent predictors of poorer OS and DFS.

Conclusion

This retrospective study with long follow-up did not show significant differences between the two groups in OS and DFS.

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Acknowledgments

The authors thank Dr. Roberto Passera, Department of Medical Sciences, University of Torino, Torino, Italy, for his help with the statistical analysis.

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Authors and Affiliations

  1. Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy

    Marco E. Allaix, Giuseppe Giraudo, Alessia Ferrarese, Alberto Arezzo, Fabrizio Rebecchi & Mario Morino

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  1. Marco E. Allaix
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  2. Giuseppe Giraudo
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  3. Alessia Ferrarese
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Correspondence to Marco E. Allaix.

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Allaix, M.E., Giraudo, G., Ferrarese, A. et al. 10-Year Oncologic Outcomes After Laparoscopic or Open Total Mesorectal Excision for Rectal Cancer. World J Surg 40, 3052–3062 (2016). https://doi.org/10.1007/s00268-016-3631-x

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