Laparoscopic Surgery for Rectal Carcinoma – Long-Term Outcomes

Authors: L. Martínek;  J. Dostalík;  I. Guňka;  P. Guňková;  P. Vávra
Authors‘ workplace: Chirurgická klinika FN Ostrava, přednosta doc. MUDr. Jan Dostalík, CSc.
Published in: Rozhl. Chir., 2009, roč. 88, č. 11, s. 675-680.
Category: Monothematic special - Original


Laparoscopic surgery for rectal cancer is still debated. The aim of this study was to compare long-term results for patients undergoing laparoscopic or open surgery for rectal cancer.

Material and methods:
The study included a group of 196 patients who underwent elective operation for rectal cancer using laparoscopic (103 patients) or open technique (93 patients) from 1 January 2001 to 31 December 2006. It was a unicentric, comparative, non-randomized clinical study. Monitored data included characteristics of patients, surgery data, tumour characteristics and long-term outcomes. The main objective was the comparison of long-term outcomes. Three- and five-year overall survival, Kaplan-Meier curves of cumulative survival and recurrence rate were compared. P-value < 0.05 was interpreted as statistically significant result.

Long-term results were obtained from, 180 patients, 8 patients of the laparoscopic group and 8 patients of the open surgery were lost. Although the study was not a randomised one, both groups were comparable in terms of sex, age, body mass index, tumour characteristics, types of procedure, neoadjuvancy and proportion of curative an palliative surgeries. Total three-year survival after open or laparoscopic procedure for all patients was 57% and 62% respectively, curative operations 71% and 79% respectively, stage I 100% and 90% respectively, stage II 89% and 80% respectively, stage III 54% vs. 75%, stage IV 8% vs. 15%. Total five-year survival after open or laparoscopic technique for all patients was 46% and 55% respectively, curative operations 60% and 75% respectively, stage I 88% and 86% respectively, stage II 87% and 83% respectively, stage III 41% vs. 72%, stage IV 0% in both groups. Except for significantly better five-year survival in group of laparoscopic technique and stage III (p = 0.0381), we reported no difference in long-term survival. The same results, i.e. no difference in long-term survival, with better outcomes in group of patients with laparoscopy and stage III (p = 0.01677) were obtained by analysis of cumulative survival curves. We proved no difference in incidence of local recurrence, distant recurrence and generalisation of the disease.

In this nonrandomized single centre study the long-term oncologic outcomes were not significantly different in group of patients undergoing laparoscopic surgery for rectal cancer. The probability of survival in the laparoscopic group for stage III carcinoma was conversely significantly better.

Key words:
laparoscopy – rectal cancer – oncological outcomes


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