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Multicentre propensity score-matched analysis of laparoscopic versus open surgery for T4 rectal cancer

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Abstract

Background

The use of laparoscopy for advanced-stage rectal cancer remains controversial. This study aimed to compare the operative and oncologic outcomes of laparoscopic (LAR) versus open anterior rectal resection (OAR) for patients with pT4 rectal cancer.

Methods

This is a multicenter propensity score matching (PSM) study of patients undergoing elective curative-intent LAR or OAR for pT4 rectal cancer (TNM stage II/III/IV) between 2005 and 2015.

Results

In total, 137 patients were included in the analysis. After PSM, demographic, clinical and tumor characteristics were similar between the 52 LAR and the 52 OAR patients. Overall, 52 tumors were located in the high rectum, 25 in the mid-rectum and 27 in the low rectum. Multivisceral resection was performed in 26.9% of LAR and 30.8% of OAR patients (p = 0.829). Conversion was required in 11 LAR patients (21.2%). The LAR group showed significantly shorter time to flatus (3.13 vs. 4.97 days, p = 0.001), time to regular diet (3.59 vs. 6.36 days, p < 0.0001) and hospital stay (15.49 vs. 17.96 days, p = 0.002) compared to the OAR group. The 90-day morbidity and mortality were not different between groups. In the majority of patients (85.6%), R0 resection was achieved. A complete mesorectal excision was obtained in 82.7% of LAR and 78.8% of OAR patients (p = 0.855). The 1-, 2- and 3-year overall survival rates were, respectively, 95.6, 73.8 and 66.7% for the LAR group and 86.7, 66.9 and 64.1% for the OAR group (p = 0.219). The presence of synchronous metastases (hazard ratio 2.26), R1 resection (HR 2.71) and lymph node involvement (HR 2.24) were significant predictors of overall survival.

Conclusion

The present study suggests that LAR for pT4 rectal cancer can achieve good pathologic and oncologic outcomes similar to open surgery despite the risk of conversion. Moreover, laparoscopy offers the benefits of a faster recovery and a shorter hospital stay.

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Acknowledgements

The author would like to thank Dr. Maria Clotilde Carra for her help and support in performing statistical analysis.

Author information

Authors and Affiliations

  1. Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France

    Nicola de’Angelis, Filippo Landi, Aleix Martínez-Pérez & Francesco Brunetti

  2. Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d’Hebron, Barcelona, Spain

    Filippo Landi, Alejandro Solis, Francesc Vallribera & Eloy Espin

  3. Universidad Autonoma de Barcelona, UAB, Barcelona, Spain

    Filippo Landi, Alejandro Solis, Francesc Vallribera & Eloy Espin

  4. Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland

    Giulio Cesare Vitali, Michela Assalino & Frédéric Ris

  5. Department of Digestive Surgery, University Hospital of Strasbourg, 67091, Strasbourg, France

    Riccardo Memeo, Henry Alexis Mercoli, Jacques Marescaux & Didier Mutter

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  1. Nicola de’Angelis
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  2. Filippo Landi
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Correspondence to Nicola de’Angelis.

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Nicola de’Angelis, Filippo Landi, Giulio Cesare Vitali, Riccardo Memeo, Aleix Martínez-Pérez, Alejandro Solis, Michela Assalino, Francesc Vallribera, Henry Alexis Mercoli, Jacques Marescaux, Didier Mutter, Frédéric Ris, Eloy Espin and Francesco Brunetti have no conflicts of interest to disclose with regard to the results of this study.

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de’Angelis, N., Landi, F., Vitali, G.C. et al. Multicentre propensity score-matched analysis of laparoscopic versus open surgery for T4 rectal cancer. Surg Endosc 31, 3106–3121 (2017). https://doi.org/10.1007/s00464-016-5332-9

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