Ahmet C Dural, MD, Metin Keskin, MD, Emre Balik, MD, Murat Akici, MD, Enver Kunduz, MD, Sumer Yamaner, MD, Oktar Asoglu, MD, Mine Gulluoglu, MD, Dursun Bugra, MD
Istanbul University School of Medicine, General Surgery Department, Istanbul, Turkey; Istanbul University School of Medicine, Department of Pathology, Istanbul, Turkey
Background: Circumferential resection margin (CRM) is one of the main prognostic factors in rectal cancer. The aim of this study was to evaluate the influence of the laparoscopic rectal cancer surgery on CRM involvement.
Methods: The medical records of 579 patients who underwent laparoscopic or open resection for rectal cancer from October 2002 to August 2008 were reviewed. Primary endpoint was CRM status. Secondary endpoints were local recurrence rate, overall and disease free survival.
Results: Laparoscopic resections performed in 266 patients (46%), while the rest underwent open (n=313, 54%) resection. Sphincter preserving surgery was performed in 374 patients (64.5%), (77.4% laparoscopic vs 53.6% open). The demographic data of the two groups were similar. The operative time of the laparoscopy group was significantly longer (p<0.001), whereas postoperative recovery was significantly better than the open surgery group in terms of oral intake and shorter hospital stay (p<0.001 and p<0.001 respectively). Only 32 (5.5%) patients were found to had CRM involvement. Rates of CRM involvement were similar between laparoscopic and open groups (5.6% vs. 5.4%) respectively. T and N stages of the tumors were directly correlated with CRM involvement (p=0.003 and p=0.0025, respectively). The mean follow-up period was 58.9 months (48-127 months). The incidence of local recurrence for CRM negative group was 8.2% (8.1% laparoscopic vs. 8.3% open), while local recurrence rate was 34.3% for CRM positive group (20% laparoscopic vs. 47% open). This difference in local recurrence rate between two groups might be associated with selecting suitable patients for laparoscopy during the learning curve period. CRM positivity was highly correlated with the local recurrence (p<0.001). The 5-year survival for CRM negative patients was 71.7% (74.9% laparoscopic vs. 68.9% open). The 5-year survival for CRM positive patients was 53.1% (66.7% laparoscopic vs. 41.2% open). CRM positivity was correlated with the 5-year survival and the 5-year disease free survival (p=0.009 and p=0.001 respectively).
Conclusion: Laparoscopic surgery for colorectal cancer is widely accepted due to its benefits of earlier recovery and shorter hospital stay. Similar CRM involvement and survival rates with laparoscopic resection have been recently reported with the increase in technical skills. Optimal postoperative clinical results can be obtained with surgeons who have adequate experience of colorectal surgery and laparoscopic skills.
Program Number: P014