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Laparoscopic-assisted abdominoperineal resection for low rectal cancer provides a shorter length of hospital stay while not affecting the recurrence or survival: a propensity score-matched analysis

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Abstract

Purpose

To compare the short- and intermediate-term outcomes of open versus laparoscopic abdominoperineal resection (APR) for low rectal cancer.

Methods

Elective open and laparoscopic APRs were identified in a prospective database and were 1:1 propensity score-matched for age, ASA grade, tumour stage and type of neoadjuvant therapy. The short- and intermediate-term outcomes were compared.

Results

From January 2003 until June 2013, a total of 135 APRs (87 open, 48 laparoscopic) were identified and matched (n = 96, standardised mean difference of covariates <0.25). The thirty-day mortality, R0 rate, lymph nodes harvested and reoperations were similar. The length of the hospital stay was shorter in the laparoscopic group [10 versus 14 days, p = 0.004 (Mann–Whitney U test), Bonferroni-corrected significance level = 0.0083]. The median follow-up was 4.6 (IQR: 2.0–6.0) years. The overall and recurrence-free 3-year survival rate estimates (Kaplan–Meier method; 95 % CI in brackets) were 71 % (59–86) and 57 % (44–73) in the open group versus 78 % (66–92) and 72 % (60–87) in the laparoscopic group, respectively [p = 0.167 and p = 0.186 (log-rank test), respectively]. The 3-year cumulative incidence of recurrence was 27 % (15–40) in the open group and 16 % (8–29) in the laparoscopic group [p = 0.359 (Gray’s test)].

Conclusions

Compared to open APR, laparoscopic APR provided a shorter length of hospital stay while showing no intermediate-term differences in the survival or cumulative incidence of recurrence.

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Acknowledgments

The authors thank Sarah Marley for her support in reviewing and providing statistical advice on this manuscript.

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Authors and Affiliations

  1. Minimally Invasive Colorectal Unit, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK

    Manfred Odermatt, Karen Flashman, Jim Khan & Amjad Parvaiz

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  1. Manfred Odermatt
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  2. Karen Flashman
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Correspondence to Manfred Odermatt.

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Odermatt, M., Flashman, K., Khan, J. et al. Laparoscopic-assisted abdominoperineal resection for low rectal cancer provides a shorter length of hospital stay while not affecting the recurrence or survival: a propensity score-matched analysis. Surg Today 46, 798–806 (2016). https://doi.org/10.1007/s00595-015-1244-x

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  • DOI: https://doi.org/10.1007/s00595-015-1244-x

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