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Failure to rescue following proctectomy for rectal cancer: the additional benefit of laparoscopic approach in a nationwide observational study of 44,536 patients

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Abstract

Background

There is growing evidence that failure to rescue (FTR) is an important factor of postoperative mortality (POM) after rectal cancer surgery and surgical approach modified post-operative outcomes. However, the impact of laparoscopy on FTR after proctectomy for rectal cancer remains unknown. The aim of this study was to compare the rates of postoperative complications and FTR after laparoscopy vs open proctectomy for cancer.

Methods

All patients who underwent proctectomy for rectal cancer between 2012 and 2016 were included. FTR was defined as the 90-day POM rate among patients with major complications. Outcomes of patients undergoing open or laparoscopic rectal cancer surgery were compared after 1:1 propensity score matching by year of surgery, hospital volume, sex, age, Charlson score, neoadjuvant chemotherapy, tumor localization and type of anastomosis.

Results

Overall, 44,536 patients who underwent proctectomy were included, 7043 of whom (15.8%) developed major complications. The rates of major complications, POM and FTR were significantly higher in open compared to laparoscopic procedure (major complications: 19.2% vs 13.7%, p < 0.001; POM: 5.4% vs 2.3%, p < 0.001; FTR: 13.6% vs 8.3%, p < 0.001; respectively). After matching, open and laparoscopic groups were comparable. Multivariate analysis showed that age, Charlson score, sphincter-preserving procedure and surgical approach were predictive factors for FTR. Open proctectomy was found to be a risk factor for FTR (OR 1.342, IC95% [1.066; 1.689], p = 0.012) compared to laparoscopic procedure.

Conclusion

When complications occurred, patients operated on by open proctectomy were more likely to die.

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Acknowledgements

The authors thank following colleagues: C. Laueriere, A. Bruandet, A. Saudemont, M. Prodeau, K. Lecolle and H. Marquaille.

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Authors and Affiliations

  1. Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France

    Mehdi El Amrani, Caroline Valibouze, Moshe Rogosnitzky, François-René Pruvot & Philippe Zerbib

  2. Medical Information Department, Lille University Hospital, Lille, France

    Guillaume Clement, Xavier Lenne & Didier Theis

  3. Univ. Lille, EA2694 - Evaluation des Technologies de Santé et des Pratiques Médicales, 59000, Lille, France

    Xavier Lenne

  4. Department of Medical Oncology, Lille University Hospital, Lille, France

    Anthony Turpin

  5. University of Lille, Lille, France

    Mehdi El Amrani, Guillaume Clement, Xavier Lenne, Anthony Turpin, Caroline Valibouze, Didier Theis, François-René Pruvot & Philippe Zerbib

  6. University of Lille, CNRS, Inserm, CHU Lille, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, 59000, Lille, France

    Mehdi El Amrani

  7. Service de Chirurgie Digestive et Transplantation, Hôpital CLAUDE HURIEZ Rue Michel Polonovski, 59037, Lille Cedex, France

    Mehdi El Amrani

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  1. Mehdi El Amrani
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  2. Guillaume Clement
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  3. Xavier Lenne
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  9. Philippe Zerbib
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Correspondence to Mehdi El Amrani.

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Mehdi El Amrani, Guillaume Clement, Xavier Lenne, Anthony Turpin, Caroline Valibouze, Moshe Rogosnitzky, Didier Theis, François-René Pruvot and Philippe Zerbib does not have any conficts of interest or financial ties to disclose.

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El Amrani, M., Clement, G., Lenne, X. et al. Failure to rescue following proctectomy for rectal cancer: the additional benefit of laparoscopic approach in a nationwide observational study of 44,536 patients. Surg Endosc 36, 435–445 (2022). https://doi.org/10.1007/s00464-021-08303-6

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  • DOI: https://doi.org/10.1007/s00464-021-08303-6

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