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

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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.

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Acknowledgments

Dr. Keller: conception and design; acquisition of data; analysis and interpretation of data; drafting the article; critical revisions for important intellectual content; final approval of the version to be published. Drs. Zhorgami, Champagne and Stein, and Mr Swendseid: conception and design; acquisition of data; analysis and interpretation of data; drafting the article; final approval of the version to be published. Drs. Reynolds and Delaney: conception and design; analysis and interpretation of data; critical revisions for important intellectual content; final approval of the version to be published.

Disclosures

Drs. Keller, Khorgami, Champagne, Stein, Reynolds, Delaney and Mr. Swendseid have no conflicts of interest, no disclosures, and no financial interests to declare.

Funding

The authors received no funding or financial support for this project.

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Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106-5047, USA

    Deborah S. Keller, Zhamak Khorgami, Bradley J. Champagne, Harry L. Reynolds Jr., Sharon L. Stein & Conor P. Delaney

  2. School of Medicine, Case Western Reserve University, Cleveland, OH, USA

    Brian Swendseid

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  1. Deborah S. Keller
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Correspondence to Deborah S. Keller.

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Keller, D.S., Khorgami, Z., Swendseid, B. et al. Laparoscopic and converted approaches to rectal cancer resection have superior long-term outcomes: a comparative study by operative approach. Surg Endosc 28, 1940–1948 (2014). https://doi.org/10.1007/s00464-014-3419-8

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  • DOI: https://doi.org/10.1007/s00464-014-3419-8

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