Long-term oncologic outcome after laparoscopic surgery for rectal cancer
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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.
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.
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).
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.
KeywordsLaparoscopic rectal surgery Conversion Rectal cancer
The authors thank Richard John Heald for critical reading of the manuscript.
Drs. Agha, Benseler, Hornung, Gerken, Iesalnieks, Fürst, Anthuber, Jauch and Schlitt have no conflict of interest or financial ties to disclose.
- 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
- 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.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.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
- 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.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.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
- 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
- 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