A Sharpe, D Kamali, A Musbahi, Y Viswanath, A Reddy. James Cook University Hospital, Middlesbrough U.K.
Laparoscopic surgery has previously demonstrated faster post-operative recovery and fewer post-operative complications compared with open procedures, expediting faster discharge and a faster return of patient to normal activities. However, there is little evidence of the long-term quality of life after either laparoscopic or open abdominoperineal excisions in patients with lower rectal cancer. This study compared the long-term quality of life (QOL), as well as disease recurrence, in patients after laparoscopic excision with those after open abdominoperineal excision.
Patients who underwent either a laparoscopic or open abdominoperineal excision for rectal cancer between January 2009 and December 2014 at a single unit were recruited for the study. Patient demographics, peri-operative details and follow-up data were recorded and analysed. QOL was determined using the EORTC QLC-CR30 and QLC-CR29 questionnaires at a minimum of 6 months post-surgery. Chi-squared, Fisher Exact and Mann Whitney U tests were used where appropriate. A P value of <0.05 was considered to be statistically significant.
45 patients (35 male; mean age 67.4 years; 18 laparoscopic extralevator abdominoperineal excision ELAPE and 13 laparoscopic standard abdominoperineal excision SAPE versus 5 open ELAPE and 9 open SAPE) participated in the study. Length of stay (LOS) was shorter in the laparoscopic group (mean LOS 14 days; range 3-53 days) compared to the open group (mean LOS 19 days; range 8-57 days). There was one 30 day mortality (laparoscopic SAPE). Circumferential resection margin (CRM) was positive in 2 (4.4%) patients (both laparoscopic ELAPE who had CRM positivity and adjuvant treatment pre operatively). Two patients (4.4%) had R1 resections, both of whom had undergone laparoscopic ELAPE. Histological analysis confirmed a perforated tumour in one and CRM involvement despite adjuvant treatment in the other. Total recurrence was greater after laparoscopic procedure compared to open procedures (32% versus 15%, respectively). However this was not statistically significant. There was no significant difference in global health status between patients with laparoscopic procedure and those with open procedure (70.4 versus 62.5, respectively). Impotence was the most frequently reported problem encountered by both laparoscopic (83.3) and open procedure (91.7) patients.
As expected, patients undergoing laparoscopic abdominoperineal excision surgery have a shorter stay in hospital. Quality of life and rate of recurrence in patients after laparoscopic procedures are not significantly different from those in patients after open procedures. Impotence remains a significant problem for all patients and they should be well informed of this risk prior to surgery.