COMPARISON OF THE OUTCOMES OF OPEN AND LAPAROSCOPIC RECTAL CANCER SURGERIES: RESULTS FROM A PORTUGUESE REGISTRY
Abstract
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.
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References
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