Laparoscopic versus open surgery for rectal cancer: results of a prospective multicentre analysis of 4,970 patients
- 812 Downloads
To compare laparoscopic versus open surgery for rectal cancer and analyse the results of the multidisciplinary audited project on total mesorectal excision conducted in Spain.
The safety and therapeutic efficiency of laparoscopic surgery for rectal cancer are controversial due to the technical difficulties it involves. A deviation from the oncological principles of mesorectal excision would mean a potential increase in local recurrence and shorter survival.
This prospective non-randomised multicentre study includes 4,970 patients with rectal cancer. The study compares perioperative, postoperative, anatomicopathological and survival variables.
Five hundred and sixty five patients were excluded. Of the remaining 4,405, 3,018 (68.51 %) had open surgery (OS) and 1,387 (31.49 %) laparoscopic surgery (LS). The rate of anterior resections was higher in the LS group. The rate of intraoperative tumour perforation, number of red blood cell concentrates transfused and length of hospital stay were greater in the OS group, whereas surgical time was longer in the LS group. The incidence of complications was 45.6 % in the OS group and 38.3 % in the LS group. Involvement of the circumferential and distal margin, as well as unsatisfactory and partially satisfactory quality of the mesorectum, were greater in the OS group. There were no differences for local recurrence and survival rates.
According to these results, laparoscopic surgery is the best option for the surgical treatment of rectal cancer, with similar rates of local recurrence and survival, although there are oncological indicators in this study to suggest that these results can be improved with laparoscopic surgery.
KeywordsRectal cancer Total mesorectal excision Laparoscopic surgery
The authors are grateful to the participating hospitals and specialists of the Spanish Rectal Cancer Project 2006–2010.
The authors have no conflicts of interests or financial ties to declare.
- 3.Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Brown JM, Medical Research Council Conventional versus Laparoscopic-Assisted Surgery In Colorectal Cancer Trial Group (2007) Randomized trial of laparoscopic assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068CrossRefPubMedGoogle Scholar
- 4.Kang SB, Park JW, Jeong SY, Nam BH, Choi HS, Kim DW, Lim SB, Lee TG, Kim DY, Kim JS, Chang HJ, Lee HS, Kim SY, Jung KH, Hong YS, Kim JH, Sohn DK, Kim DH, Oh JH (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 11:637–645CrossRefPubMedGoogle Scholar
- 9.Wibe A, Moller B, Norstein J, Carlsen E, Wiig JN, Heald RJ, Langmark F, Myrvold HE, Søreide O, Norwegian Rectal Cancer Group (2002) A national strategic change in treatment policy for rectal cancer-implementation of total mesorectal excision as routine treatment in Norway. A National audit. Dis Colon Rectum 45:857–866CrossRefPubMedGoogle Scholar
- 14.Breukink S, Pierie J, Wiggers T (2006) Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev 18:4Google Scholar
- 15.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(4):415–421CrossRefPubMedGoogle Scholar
- 21.Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, O’Callaghan C, Myint AS, Bessell E, Thompson LC, Parmar M, Stephens RJ, Sebag-Montefiore D, MRC CR07/NCIC-CTG CO16 Trial Investigators, NCRI Colorectal Cancer Study Group (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 373:821–828CrossRefPubMedGoogle Scholar
- 25.Amato A, Pescatori M (2006) Perioperative blood transfusions for the recurrence of colorectal cancer. Cochrane Database Syst Rev (1):CD005033Google Scholar