Laparoscopic versus open surgery for rectal cancer. Surgical results and 5 year survival.

Jose Gellona, MD, Rodrigo Miguieles, MD, Gonzalo Urrejola, MD, Felipe Bellolio, MD, Maria Elena Molina, MD, Gonzalo Inostroza, MD, Daniella Espinola, MD, Jose Miguel Zuniga, Tomas Larach, MD, Alvaro Zuniga, MD

Colorectal Unit. Department of Digestive Surgery. Pontificia Universidad Catolica de Chile

Introduction: Laparoscopic approach for rectal cancer has gained acceptance due to the short term advantages of minimally invasive surgery and similar long term oncologic results. In our country several centers have adopted the technique but short and long term results are lacking. The aim of this study is to compare short term surgical and pathologic results, long term disease specific (DSS) and disease free survival (DFS) in patients submitted to radical surgery (anterior resection of the rectum or abdominoperineal resection) via laparoscopy or laparotomy for rectal cancer.

Method: Historic cohort study. Patients who underwent elective, curative radical resection for rectal cancer between August 2005 and May 2012 were included. Patients with local or simultaneous liver resection were excluded. Categorical variables were analyzed with chi square o fisher exact test; numeric variables were compared with Man Whitney or t test depending on their distribution. Survival function DSS and disease free DFS survival were estimated with the Kaplan – Meier method. The survival curves were compared with the Log Rank test.

Results: In the mentioned period, 143 patients met the inclusion criteria. 57 (39.9%) in the open approach and 86 (60.1%) in the laparoscopic approach. Both groups were comparable in age, gender, preoperative ASA score, neoadyuvant chemoradiotherapy, tumor location and final TNM stage. In the open group, anterior resection was done in 94.7% of patients versus 87.2% in the laparoscopy group (p=NS). Median surgical time was 165 (80-540) minutes in the open group and 210 (60-500) minutes in the laparoscopy group (p=0.018). Postoperative in hospital stay was 9 (6-26) and 6 (4-50) days (p<0.001) in the open and laparoscopic approach respectively. Morbidity rates were 12.3% in the open group and 16.3 in the laparoscopic group (p=NS) Reoperation rates were 3.5% and 4.6% in the open and laparoscopic group respectively (p=NS). The surgical specimen review showed no significant differences in tumor size, number of retrieved lymph nodes and margin positivity between both groups. With a median follow up of 33 (2-116) months, 5 year DSS was 81% in the open approach versus 88% in the laparoscopic approach (p=NS). DFS was 80% in the open group versus 79% in the laparoscopic group (p=NS).

Conclusion: In our series, laparoscopic approach for rectal cancer has similar surgical results compared to conventional surgery in terms of morbidity and reoperation rate. The laparoscopic approach has longer surgical time, but a lower postoperative hospital stay. Long term oncologic results did not differ between the two surgical approaches. These results are similar to the reported elsewere.


Session: Poster Presentation

Program Number: P095

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