Skip to main content

Long-Term Oncologic Outcomes of Minimally Invasive Proctectomy for Rectal Adenocarcinoma

Journal of Gastrointestinal Surgery volume 22, pages 1412–1417 (2018)Cite this article

Abstract

Background

Long-term oncologic outcomes after minimally invasive surgery (MIS) for rectal adenocarcinoma compared to open surgery continue to be debated. We aimed to review our high-volume single-institution outcomes in MIS rectal cancer surgery.

Methods

A retrospective review of a prospectively collected database was completed of all consecutive adult patients with rectal adenocarcinoma treated from January 2005 through December 2011. Stage IV or recurrent disease was excluded. Demographics and operative and pathologic details were reviewed and reported. Primary endpoints include survival and recurrence.

Results

A total of 324 patients were included and median follow-up was 54 months (IQR = 37.0, 78.8). The mean age was 58.2 ± 14.1 years. Tumors were in the upper rectum in 111 patients, mid-rectum in 113 patients, and lower rectum in 100 patients. Stage III disease was most common (49.4%). Overall conversion to open procedure rate was 13.9%. The circumferential radial margin was positive in only 1 patient (0.3%) and the mean lymph node yield was 24.7 ± 17.2. Cancer recurred in 42 patients (13%), 10 (2.5%) patients developed local recurrence, 32 (9.8%) developed distant metastasis, and 2 (0.6%) patients had both. The 5-year overall survival for stage 0, 1, 2, and 3 disease is 96, 91, 80, and 77%, respectively (p = 0.015).

Conclusion

In carefully selected rectal cancer patients treated with MIS, long-term outcomes of survival and recurrence appear to compare favorably to previously published series.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Sun Z, Kim J, Adam MA, Nussbaum DP, Speicher PJ, Mantyh CR, et al. Minimally Invasive Versus Open Low Anterior Resection: Equivalent Survival in a National Analysis of 14,033 Patients With Rectal Cancer. Ann Surg. 2015.

  2. Robinson CN, Balentine CJ, Sansgiry S, Berger DH. Disparities in the use of minimally invasive surgery for colorectal disease. J Gastrointest Surg. 2012;16(5):897–903; discussion −4.

    Article  PubMed  Google Scholar 

  3. Vennix S, Pelzers L, Bouvy N, Beets GL, Pierie JP, Wiggers T, et al. Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev. 2014;4:CD005200.

    Google Scholar 

  4. Khreiss W, Huebner M, Cima RR, Dozois ER, Chua HK, Pemberton JH, et al. Improving conventional recovery with enhanced recovery in minimally invasive surgery for rectal cancer. Dis Colon Rectum. 2014;57(5):557–63.

    Article  PubMed  Google Scholar 

  5. Green BL, Marshall HC, Collinson F, Quirke P, Guillou P, Jayne DG, et al. Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg. 2013;100(1):75–82.

    Article  PubMed  CAS  Google Scholar 

  6. Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas MH, de Lange-de Klerk ES, et al. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med. 2015;372(14):1324–32.

    Article  PubMed  CAS  Google Scholar 

  7. Kang SB, Park JW, Jeong SY, Nam BH, Choi HS, Kim DW, et al. 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. 2010;11(7):637–45.

    Article  PubMed  Google Scholar 

  8. Asoglu O, Balik E, Kunduz E, Yamaner S, Akyuz A, Gulluoglu M, et al. Laparoscopic surgery for rectal cancer: outcomes in 513 patients. World J Surg. 2013;37(4):883–92.

    Article  PubMed  Google Scholar 

  9. Dulucq JL, Wintringer P, Stabilini C, Mahajna A. Laparoscopic rectal resection with anal sphincter preservation for rectal cancer: long-term outcome. Surg Endosc. 2005;19(11):1468–74.

    Article  PubMed  Google Scholar 

  10. Ng SS, Leung KL, Lee JF, Yiu RY, Li JC, Hon SS. 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. 2009;52(4):558–66.

    Article  PubMed  Google Scholar 

  11. Agha A, Benseler V, Hornung M, Gerken M, Iesalnieks I, Furst A, et al. Long-term oncologic outcome after laparoscopic surgery for rectal cancer. Surgical endoscopy. 2014;28(4):1119–25.

    Article  PubMed  Google Scholar 

  12. Edge S, Byrd, D.R., Compton, C.C., Fritz, A.G., Greene, F.L., Trotti, A. AJCC Cancer Staging Manual. 7 ed. New York: Springer-Verlag New York; 2010.

  13. Zhou X, Liu F, Lin C, You Q, Yang J, Chen W, et al. Hand-assisted laparoscopic surgery compared with open resection for mid and low rectal cancer: a case-matched study with long-term follow-up. World J Surg Oncol. 2015;13:199.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hand-assisted laparoscopic surgery vs standard laparoscopic surgery for colorectal disease: a prospective randomized trial. HALS Study Group. Surg Endosc. 2000;14(10):896–901.

  15. Kang J, Yoon KJ, Min BS, Hur H, Baik SH, Kim NK, et al. The impact of robotic surgery for mid and low rectal cancer: a case-matched analysis of a 3-arm comparison--open, laparoscopic, and robotic surgery. Ann Surg. 2013;257(1):95–101.

    Article  PubMed  Google Scholar 

  16. Park EJ, Cho MS, Baek SJ, Hur H, Min BS, Baik SH, et al. Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery. Ann Surg. 2015;261(1):129–37.

    Article  PubMed  Google Scholar 

  17. Huscher CG, Bretagnol F, Corcione F. Laparoscopic Colorectal Cancer Resection in High-Volume Surgical Centers: Long-Term Outcomes from the LAPCOLON Group Trial. World J Surg. 2015.

  18. Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, et al. 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. 2009;373(9666):821–8.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2008;26(2):303–12.

    Article  Google Scholar 

  20. Marks JH, Huang R, McKeever D, Greenfield M. Outcomes in 132 patients following laparoscopic total mesorectal excision (TME) for rectal cancer with greater than 5-year follow-up. Surg Endosc. 2015.

  21. Simmonds PC, Primrose JN, Colquitt JL, Garden OJ, Poston GJ, Rees M. Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer. 2006;94(7):982–99.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Wei AC, Greig PD, Grant D, Taylor B, Langer B, Gallinger S. Survival after hepatic resection for colorectal metastases: a 10-year experience. Ann Surg Oncol. 2006;13(5):668–76.

    Article  PubMed  Google Scholar 

  23. Booth CM, Nanji S, Wei X, Biagi JJ, Krzyzanowska MK, Mackillop WJ. Surgical resection and peri-operative chemotherapy for colorectal cancer liver metastases: A population-based study. Eur J Surg Oncol. 2015.

  24. Booth CM, Nanji S, Wei X, Mackillop WJ. Outcomes of Resected Colorectal Cancer Lung Metastases in Routine Clinical Practice: A Population-Based Study. Ann Surg Oncol. 2015.

  25. Tepper JE, O'Connell M, Hollis D, Niedzwiecki D, Cooke E, Mayer RJ. Analysis of surgical salvage after failure of primary therapy in rectal cancer: results from Intergroup Study 0114. J Clin Oncol. 2003;21(19):3623–8.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Affiliations

  1. Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, 32224, USA

    Amit Merchea

  2. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Shahzad M. Ali

  3. Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA

    Scott R. Kelley, Emilie Duchalais, Jasim Y. Alabbad, Eric J. Dozois & David W. Larson

Authors
  1. Amit Merchea
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shahzad M. Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Scott R. Kelley
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emilie Duchalais
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jasim Y. Alabbad
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eric J. Dozois
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. David W. Larson
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors have met the following criteria:

- Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work

- Drafting the work or revising it critically for important intellectual content

- Final approval of the version to be published

- Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

Corresponding author

Correspondence to Amit Merchea.

Ethics declarations

Institutional review board approval was obtained.

Conflict of Interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Merchea, A., Ali, S.M., Kelley, S.R. et al. Long-Term Oncologic Outcomes of Minimally Invasive Proctectomy for Rectal Adenocarcinoma. J Gastrointest Surg 22, 1412–1417 (2018). https://doi.org/10.1007/s11605-018-3751-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-018-3751-8

Keywords

  • Rectal cancer
  • MIS
  • Proctectomy
  • Rectal adenocarcinoma
  • Minimally invasive surgery