Advertisement

Surgical Endoscopy

, Volume 28, Issue 4, pp 1119–1125 | Cite as

Long-term oncologic outcome after laparoscopic surgery for rectal cancer

  • Ayman Agha
  • Volker Benseler
  • Matthias Hornung
  • Michael Gerken
  • Igors Iesalnieks
  • Alois Fürst
  • Matthias Anthuber
  • Karl-Walter Jauch
  • Hans J. Schlitt
Article

Abstract

Background

Recent studies demonstrated favorable short- and mid-term results after laparoscopic surgery for rectal cancer. However, long-term results from large series are lacking. The present study analyses long-term results of laparoscopic rectal cancer surgery from a large-volume center.

Methods

From January 1998 until March 2005, 225 patients underwent laparoscopic rectal resection due to carcinoma at the Medical Centre of the University of Regensburg. From 224 patients, a follow-up over 10 years was performed using the data of the Tumour Centre of the University of Regensburg. The data were analysed using oncological data (tumour recurrence) as well as overall survival. In addition, the effect of conversion to open resection on overall survival was analysed.

Results

With a median of 10 years at follow-up, the overall and disease-free survival was 50.5 and 50.1 %, respectively. Local recurrence of all patients was 5.8 % and none of the converted patients was within this group. The median time interval for the development of local recurrence was 30 months. Six of the 13 patients with local recurrence (46.1 %) had received neoadjuvant radiochemotherapy before surgery. Patients with a conversion to open surgery had primarily a significantly worse outcome than patients resected completely laparoscopically (p = 0.003). However, this difference was no longer apparent using a multivariant analysis (hazard ratio 1.221; p = 0.478).

Conclusions

Overall survival and local recurrence rate of patients undergoing laparoscopic resection of rectal cancer are comparable to open surgery. However, in our analysis, patients undergoing laparoscopic anterior resection had a higher survival rate compared with patients with abdominoperineal resection.

Keywords

Laparoscopic rectal surgery Conversion Rectal cancer 

Abbreviations

AR

Anterior resection

APR

Abdominoperineal resection

Notes

Acknowledgments

The authors thank Richard John Heald for critical reading of the manuscript.

Disclosures

Drs. Agha, Benseler, Hornung, Gerken, Iesalnieks, Fürst, Anthuber, Jauch and Schlitt have no conflict of interest or financial ties to disclose.

References

  1. 1.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726. doi: 10.1016/S0140-6736(05)66545-2 CrossRefPubMedGoogle Scholar
  2. 2.
    Agha A, Fürst A, Hierl J, Iesalnieks I, Glockzin G, Anthuber M, Jauch K-W, Schlitt HJ (2008) Laparoscopic surgery for rectal cancer: oncological results and clinical outcome of 225 patients. Surg Endosc 22:2229–2237. doi: 10.1007/s00464-008-0028-4 CrossRefPubMedGoogle Scholar
  3. 3.
    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 97:1638–1645. doi: 10.1002/bjs.7160 CrossRefPubMedGoogle Scholar
  4. 4.
    Fürst A, Schwandner O, Heiligensetzer A, Iesalnieks I, Agha A (2010) Laparoscopic TME in rectal cancer–electronic supplementary: op-video. Langenbecks Arch Surg Dtsch Ges Für Chir 395:181–183. doi: 10.1007/s00423-009-0556-y CrossRefGoogle Scholar
  5. 5.
    Laurent C, Leblanc F, Wütrich P, Scheffler M, Rullier E (2009) Laparoscopic versus open surgery for rectal cancer: long-term oncologic results. Ann Surg 250:54–61. doi: 10.1097/SLA.0b013e3181ad6511 CrossRefPubMedGoogle Scholar
  6. 6.
    Kim J-G, Heo Y-J, Son G-M, Lee Y-S, Lee I-K, Suh Y-J, Cho H-M, Chun C-S (2009) Impact of laparoscopic surgery on the long-term outcomes for patients with rectal cancer. Anz J Surg 79:817–823. doi: 10.1111/j.1445-2197.2009.05109.x CrossRefPubMedGoogle Scholar
  7. 7.
    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 96:982–989. doi: 10.1002/bjs.6662 CrossRefPubMedGoogle Scholar
  8. 8.
    Huang M-J, Liang J-L, Wang H, Kang L, Deng Y-H, Wang J-P (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 26:415–421. doi: 10.1007/s00384-010-1091-6 CrossRefPubMedGoogle Scholar
  9. 9.
    Ng SSM, Leung KL, Lee JFY, Yiu RYC, Li JCM, Hon SSF (2009) Long-term morbidity and oncologic outcomes of laparoscopic-assisted anterior resection for upper rectal cancer: ten-year results of a prospective, randomized trial. Dis Colon Rectum 52:558–566. doi: 10.1007/DCR.0b013e31819ec20c CrossRefPubMedGoogle Scholar
  10. 10.
    Green BL, Marshall HC, Collinson F, Quirke P, Guillou P, Jayne DG, Brown JM (2013) Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg 100:75–82. doi: 10.1002/bjs.8945 CrossRefPubMedGoogle Scholar
  11. 11.
    Hermanek P, Hermanek P, Hohenberger W, Klimpfinger M, Köckerling F, Papadopoulos T (2003) The pathological assessment of mesorectal excision: implications for further treatment and quality management. Int J Colorectal Dis 18:335–341. doi: 10.1007/s00384-002-0468-6 PubMedGoogle Scholar
  12. 12.
    Merkel S, Wang WY, Schmidt O, Dworak O, Wittekind C, Hohenberger W, Hermanek P (2001) Locoregional recurrence in patients with anastomotic leakage after anterior resection for rectal carcinoma. Color Dis Off J Assoc Coloproctology Gt Br Irel 3:154–160Google Scholar
  13. 13.
    Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens J-H, Liersch T, Schmidberger H, Raab R (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740. doi: 10.1056/NEJMoa040694 CrossRefPubMedGoogle Scholar
  14. 14.
    Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, Becker H, Raab H-R, Villanueva M-T, Witzigmann H, Wittekind C, Beissbarth T, Rödel C (2012) Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol Off J Am Soc Clin Oncol 30:1926–1933. doi: 10.1200/JCO.2011.40.1836 CrossRefGoogle Scholar
  15. 15.
    Van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, Bonjer HJ (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218. doi: 10.1016/S1470-2045(13)70016-0 CrossRefPubMedGoogle Scholar
  16. 16.
    Agha A, Fürst A, Iesalnieks I, Fichtner-Feigl S, Ghali N, Krenz D, Anthuber M, Jauch KW, Piso P, Schlitt HJ (2008) Conversion rate in 300 laparoscopic rectal resections and its influence on morbidity and oncological outcome. Int J Colorectal Dis 23:409–417. doi: 10.1007/s00384-007-0425-5 CrossRefPubMedGoogle Scholar
  17. 17.
    Mroczkowski P, Hac S, Smith B, Schmidt U, Lippert H, Kube R (2012) Laparoscopy in the surgical treatment of rectal cancer in Germany 2000-2009. Color Dis Off J Assoc Coloproctology Gt Br Irel 14:1473–1478. doi: 10.1111/j.1463-1318.2012.03058.x Google Scholar
  18. 18.
    Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P (2011) Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 253:890–899. doi: 10.1097/SLA.0b013e3182128929 CrossRefPubMedGoogle Scholar
  19. 19.
    Eberhardt JM, Kiran RP, Lavery IC (2009) The impact of anastomotic leak and intra-abdominal abscess on cancer-related outcomes after resection for colorectal cancer: a case control study. Dis Colon Rectum 52:380–386. doi: 10.1007/DCR.0b013e31819ad488 CrossRefPubMedGoogle Scholar
  20. 20.
    Krarup P-M, Nordholm-Carstensen A, Jorgensen LN, Harling H (2013) Anastomotic leak increases distant recurrence and long-term mortality after curative resection for colonic cancer: a nationwide cohort study. Ann Surg. doi: 10.1097/SLA.0b013e3182a6f2fc Google Scholar
  21. 21.
    Mohr A, Polz J, Martin EM, Griessl S, Kammler A, Pötschke C, Lechner A, Bröker BM, Mostböck S, Männel DN (2012) Sepsis leads to a reduced antigen-specific primary antibody response. Eur J Immunol 42:341–352. doi: 10.1002/eji.201141692 CrossRefPubMedGoogle Scholar
  22. 22.
    Ptok H, Steinert R, Meyer F, Kröll K-P, Scheele C, Köckerling F, Gastinger I, Lippert H (2006) Long-term oncological results after laparoscopic, converted and primary open procedures for rectal carcinoma. Results of a multicenter observational study. Chirurg 77:709–717. doi: 10.1007/s00104-006-1199-y CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Ayman Agha
    • 1
  • Volker Benseler
    • 1
  • Matthias Hornung
    • 1
  • Michael Gerken
    • 2
  • Igors Iesalnieks
    • 1
    • 3
  • Alois Fürst
    • 1
    • 4
  • Matthias Anthuber
    • 1
    • 5
  • Karl-Walter Jauch
    • 1
    • 6
  • Hans J. Schlitt
    • 1
  1. 1.Department of Surgery, University Medical Centre RegensburgUniversity of RegensburgRegensburgGermany
  2. 2.Tumour Center RegensburgRegensburgGermany
  3. 3.Department of SurgeryMarienhospital GelsenkirchenGelsenkirchenGermany
  4. 4.Department of SurgeryCaritas-Krankenhaus St. Josef, RegensburgRegensburgGermany
  5. 5.Department of SurgeryKlinikum AugsburgAugsburgGermany
  6. 6.Department of SurgeryUniversity of Munich Campus GrosshadernMunichGermany

Personalised recommendations