Analysis Of The Effect And Prognosis Of Laparoscopic Surgery For Non-metastatic Rectal Cancer

Laparoscopic surgery for rectal cancer is commonly performed in China and several randomized controlled trials have been suggested.However,compared with open surgery,the effectiveness of laparoscopic surgery has not been sufficiently proved,especially the long-term survival.Part Ⅰ:Long-term oncologic outcomes and short-term surgical safety of laparoscopic versus open surgery for non-metastatic rectal cancer:a two-centre propensity score matching cohort studyObjective:The aim of this study was to evaluate the long-term survival outcomes and short-term surgical safety between laparoscopic and open surgery for stage I-III rectal cancer.Methods:Data of eligible patients with non-metastatic rectal cancer from 2012 to 2014 were retrospectively reviewed.Long-term survival outcomes and short-term surgical safety were analyzed with propensity score matching between groups.Results:Of 430 cases collated from two institutes,103 matched pairs were evaluated after performing propensity score matching.In matched cohorts,the estimated blood loss during laparoscopic surgery was significantly less than that during open surgery(P=0.019).In the laparoscopic group,the operative time and hospital stay were shorter than in the open group(P<0.001).The incidence of postoperative complications was 9.7%in the laparoscopic group and 10.7%in the open group(P=0.818).Overall survival,relapse-free survival and cancer-specific survival were similar in both groups(P>0.1).An elevated carcinoembryonic antigen,less than 12 harvested lymph nodes and perineural invasion were the significant prognostic factors affecting overall survival and relapse-free survival.Compared with open surgery,the overall survival and cancer-specific survival of laparoscopic surgery for male,stage Ⅲ,moderate BMI or upper rectal cancer tended to decreased.Laparoscopic surgery for stage Ⅱ,moderate BMI or middle rectal cancer has an increased trend of recurrence compared with open surgery.Conclusion:Open surgery should be the priority recommendation,but laparoscopic surgery is also an acceptable treatment for non-metastatic rectal cancer,limited to appropriate cases,based on the long-term and short-term results of this cohort study.These favorable outcomes require future confirmation by high-quality studies.Part Ⅱ:Prognosis following laparoscopic surgery for non-metastatic rectal cancerObjective:The aim of this study was to investigate the hypothesis that survival outcomes following laparoscopic surgery was better than following open surgery for non-metastatic rectal cancer.Methods:Data from patients with clinical stage Ⅰ to Ⅲ rectal cancer were collected and analyzed.The operations were performed from 2012 to 2014.Propensity score matching was performed to control the bias.To identify the prognostic factors for survival,univariate and multivariate analyses were performed.Results:Of 430 cases collated from 2 institutes,347 cases were eligible for analysis.The cases were matched into 102 laparoscopic and 102 open cases.At the time of last follow-up,overall survival rates were 73.5%and 79.4%in the laparoscopic and open groups(hazard ratio(HR)1.32;95%confidence interval(CI)0.75-2.34),respectively.Relapse-free survival rates were 72.5%for laparoscopic surgery and 76.5%for open surgery(HR 1.20;95%CI 0.69-2.06).The rate of cancer-specific survival was 79.4%with a laparoscopic surgery and 88.2%with open surgery(HR 1.64;95%CI 0.82-3.28).The recurrence rates of laparoscopic surgery and open surgery were 21.6%and 14.7%(HR 1.60;95%CI 0.77-3.29),respectively.An elevated carcinoembryonic antigen,less than 12 harvested lymph nodes and perineural invasion were the significant prognostic factors affecting overall survival and relapse-free survival.And perineural invasion was the only significant prognostic factor affecting cancer-specific survival.Conclusion:Patients receiving laparoscopic rectal cancer surgery were found to have higher rates of recurrences,worse survival than open surgery.Laparoscopic surgery may not be the first choice for non metastatic rectal cancer and should be considered as a treatment option,limited to appropriate cases.