COMPARISON OF THE OUTCOMES OF OPEN AND LAPAROSCOPIC RECTAL CANCER SURGERIES: RESULTS FROM A PORTUGUESE REGISTRY
Introduction: This study aimed to compare the 3-year rates of local recurrence (LR) and overall survival (OS) for open (OPEN) and laparoscopic (LAP) surgeries in a Portuguese registry.
Material and Methods: This observational study included patients who underwent rectal cancer resection performed in 16 hospitals between July 2014 and December 2019. The radiologic staging and the specimen images of the first three cases of any hospital were uploaded and audited by the scientific committee. Clinical and pathological characteristics and short and long-term outcomes of OPEN and LAP surgeries were analyzed.
Results: The registry included 640 patients who underwent rectal cancer surgery: 562 (87.8%) underwent curative resection and 78 (12.2%) underwent palliative resection. In the curative cohort, OPEN surgery was performed in 269 cases whereas LAP surgery, which had a conversion rate of 17.5%, was performed in 266 cases. The pN staging showed that the LAP group had less advanced disease than the OPEN group. Anterior resection was performed in 57.8% of the cases whereas abdominoperineal resection was performed in 16.5%. Patients who underwent LAP surgery had shorter hospital stays. The 3-year LR rate was 3.0% (95% CI, 1.4%-6.3%) for LAP surgery and 8.3% (95% CI, 5.1%-13.1%) for OPEN surgery (P=0.02). The 3-year OS was 88.2% (95% CI, 83.1%-92.0%) for LAP surgery and 76.5% (95% CI, 69.1%-82.6%) for OPEN surgery (P=0.0061).
Discussion: LAP surgery for patients with rectal cancer is associated with a decreased LR rate and improved OS, although in those with less advanced pN staging.
Conclusion: The data support the view that the LAP approach is justified for rectal cancer when performed by surgeons with appropriate laparoscopic experience.
2 Ortiz H, Wibe A, Ciga MA et al. Impact of a multidisciplinary team training programme on rectal cancer outcomes in Spain. Colorectal Dis 2013;15:544-551.
3 Bosch SL, Nagtegaal ID. The importance of the pathologist’s role in assessment of the quality of the mesorectum. Curr Colorectal Cancer Rep 2012;8:90-98.
4 Leonard D, Penninckx F, Fieuws S, et al. PROCARE, a multidisciplinary Belgian Project on Cancer of the Rectum. Factors Predicting the Quality of Total Mesorectal Excision for Rectal Cancer. Ann Surg 2010;252:982-988.
5 Veldkamp R, Kuhry E, Hop WC, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 2005;6:477-484.
6 van der Pas MH, Haglind E, Cuesta MA, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 2013;14:210-218.
7 Fleshman J, Branda M, Sargent DJ, et al. Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA 2015;314:1346-1355.
8 Stevensen AR, Soloman MJ, Lumley JW, et al. Effect of laparoscopic-assisted reaction vs open resectionon pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA 2015;314:1356-1363.
9 Fleshman J, Branda ME, Sargent DJ, et al. Disease-free survival and local recurrence for laparoscopic resection compared with open resection of stage II to III rectal cancer: follow-up results of the ACOSOG Z6051 randomized controlled trial. Ann Surg 2019;269:589-595.
10 Stevenson ARL, Soloman MJ, Brown CSB, et al. Disease-free survival and local recurrence after laparoscopic-assisted resection or open resection for rectal cancer: the Australasian laparoscopic cancer of the rectum randomized clinical trial. 2019;269:596-602.
11 www.spcir.com Cancro do Reto – Registo nacional
13 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213.
14 Ortiz H, Wibe A, Ciga M, et al. on behalf of the Spanish Rectal Cancer Project. Multicenter study of outcome in relation to the type of resection in rectal cancer. Dis Colon Rectum 2014;57:811–822.
15 Dutch Snapshot Research Group. Benchmarking recent national practice in rectal cancer treatment with landmark randomized controlled trials. Colorectal Dis. 2017;19(6):O219-O231.
16 Bonjer HJ, Deijen CL, Abis GA et al. for the COLOR II study group. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 2015; 372: 1324–1332.
17 Jeong SY, Park JW, Nam BH, et al. Open versus laparoscopic surgery for midrectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, noninferiority, randomised controlled trial. Lancet Oncol 2014;15:767-774.
18 van der Pas MH, Haglind E, Cuesta MA, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 2013;14:210-8.
19 Mathis KL, Nelson H. Laparoscopic proctectomy for cancer. Ann Surg 2019;269:603-604.
20 Harrysson IJ, Cook J, Sirimanna P, Feldman LS, Darzi A, Aggarwal R. Systematic review of learning curves for minimally invasive abdominal surgery: a review of the methodology of data collection, depiction of outcomes, and statistical analysis. Ann Surg 2014;260:37-45.
21 Beck N, van Bommel, Eddes E, et al. The Dutch Institute for Clinical Auditing. Achieving Codman’s dream as a nationwide basis. Ann Surg 2020;271:627-631.