Comparison of Eary and Late Experience for Laparoscopic Low Rectal Cancer Resection ; Perioperative Outcome and Survival Analysis; Prospective Cohort Study

Purpose: Indications of laparoscopic rectal resection are continually increasing worldwide, but technical difficulties have been encountered in laparoscopic low rectal resection.
The aim of this study is to compare perioperative outcome and its impact on two-years survival for early and late experience groups from one colorectal surgeon.
Methods: Review a database of all 69 laparoscopic resection for low rectal cancer (less than 7 cm. from anal verge) between June 2004 to Jan 2007, perform by one colorectal surgeon with self-trained laparoscopic colorectal surgery.
Two consecutive groups are analyzed: Eary experience = case 1 to 35 (35), Late experience = case 36 and higher (34). Pearson’s chi-square, fisher’sExact test and ANOVA are used to compare differences in demographics and perioperative parameters. Survival analysis is analyzed by the Kaplan-Meier method and the log rank tests.
Results: There are no significant differences between two groups with respect to age, sex, BMI, comorbidities, staging or distance of anastomotic line from anal verge.
Mean operative time (368vs296, p=0.000) and mean blood loss (477vs163, p=0.010) decline significantly with late experience. There are no differences in the rate of anastomotic leakage (5vs2, p=0.396) between two groups. However,there are three conversions in early experience group because of technical difficulty (3vs0,p=0.23).
The same result is showed after devided all 69 patients for 3 consecutive groups: A (1-23), B (23-46), C (46-69). Group C show significantly shorter operative times than group A (p=0.000) and group B (p=0.001) respectively.
Recurrence is noted in two patients (local and port site) for early experience group (2vs0,p = 0.368) and also no different significantly for distant metastases (6vs1,p=0.263).
There are differences significantly in two-year DFS rates (88%vs100%, p=0.042). Overall 2-year survival was 91%vs 100% (p=0.081).
Conclusions: Perioperative and two-year outcomes after laparoscopic resection of low rectal cancer will be better after 35-46 procedures in this study, base on a decline in operating time, blood loss and recurrence rate.

Session: Poster

Program Number: P144

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