The Impact of Postoperative Complications To Long-term Oncologic Outcomes of Laparoscopic Low Anterior Resection for Rectal Cancer

Eun Jung Park, MD, Seung Hyuk Baik, MD, PhD, Jeonghyun Kang, MD, Byung Soh Min, MD, PhD, Kang Young Lee, MD, PhD, Nam Kyu Kim, MD, PhD, Seung-Kook Sohn, MD, PhD. Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea

INTRODUCTION We aimed to investigate the impact of postoperative complications to long-term oncologic outcomes in patients who underwent laparoscopic low anterior resection for rectal cancer.

METHODS AND PROCEDURES From January 2005 to April 2011, we evaluated a total of 362 consecutive patients (218 males and 144 females) who underwent laparoscopic low anterior resection for rectal cancer (pathologic stage I (n=133), stage II (n=97), stage III (n=108)) at Severance Hospital, Yonsei University College of Medicine, Korea. Median follow-up period was 55 months (range, 37–112 months). Perioperative clinicopathologic outcomes, and 5-year survival rates were evaluated between the patients with and without postoperative complications. Postoperative complications were graded by the Dindo classification. The periods, in which postoperative complications occurred were compared between the acute (before postoperative 14 days) and the chronic (after postoperative 14 days) period. The 5-year overall, disease-free survival rates and cumulative incidence of local recurrence were calculated by using the Kaplan–Meier method and the log-rank test. A p-value of less than 0.05 was considered statistically significant.

RESULTS The 5-year overall survival rate was 93.8% in the patient with postoperative complications, and 96.2% in patients without postoperative complications (P=0.240). The 5-year disease-free survival rate was 90.3% and 94.6%, respectively (P=0.016). Local recurrence of the patients with complications was higher than without complications: 8.5% vs. 2.3%, respectively (P=0.006). Postoperative complications in the acute period had higher disease-free survival rate than the chronic period: 90.7% and 87.6%, respectively (P=0.006). Patients who had postoperative complications more than grade III of the Dindo classification had lower disease-free survival rates than grades I – II: 86.5% and 94.9%, respectively (P=0.004). The overall survival rate which was analyzed by the postoperative developing period (acute vs. chronic period) and Dindo classification (grades I – II vs. grades III – IV) showed no significant difference. Subgroup analysis of the overall survival rate by stages showed no significant difference in all stages. However, the disease-free survival rate by stages showed significant difference in stage I (disease-free survival rate of stage I with complications vs. without complications, 88.9% vs. 96.3%, p=0.002).

CONCLUSION Postoperative outcomes after laparoscopic low anterior resection for rectal cancer resulted in lower rates of the 5-year disease-free survivals and higher rates of local recurrence. Patients who had complications after 14 postoperative days and more than grade III of the Dindo classification showed a lower disease-free survival rate. These findings can support that a more careful operation is required because postoperative morbidities are related to the poor oncologic outcomes.image

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