Short-term Outcomes of Laparoscopically Assisted Surgery for Rectal Cancer Following Neoadjuvant Chemoradiotherapy: A Single-Center Experience

J Surg Res. 2014 Apr;187(2):438-44. doi: 10.1016/j.jss.2013.10.039. Epub 2013 Oct 22.

Abstract

Objective: The efficacy of laparoscopic treatment of rectal cancer remains unclear, and little is known about its effect on sphincter preservation. We compared short-term outcomes of laparoscopically assisted and open surgeries following neoadjuvant chemoradiotherapy (CRT) for mid and low rectal cancer.

Methods: This study enrolled 137 patients with mid-low rectal cancer who underwent curative resection, 51 by laparoscopically assisted (Lap group) and 86 by conventional open (Open group) surgeries, following neoadjuvant CRT from July 2007 to July 2012. The clinical and surgical findings of the two groups of patients were prospectively collected and analyzed.

Results: Three patients (5.9%) in the Lap group were converted to an open procedure. The mean operating times were similar in both groups. The Lap group had a significantly higher rate of sphincter preservation (62.7% versus 41.9%, P = 0.018) and significantly lower mean blood loss than the Open group. Mean times to first flatus, start of a normal diet, and overall postoperative hospitalization were longer for open surgery. The complication rate (11.8% versus 31.4%, P = 0.009) was significantly lower in the Lap group. Mean distal resection margin, involvement of the circumferential resection margin (2.0% versus 3.5%, P = 1.000), and mean lymph nodes harvested (12 versus 11; P = 0.242) were equivalent in the two groups.

Conclusions: Laparoscopically assisted surgery following neoadjuvant CRT is safe for patients with rectal cancer and provides favorable short-term benefits but without compromising oncologic outcomes. This sphincter-preserving procedure may be a treatment of choice for patients with lower rectal cancer.

Keywords: Laparoscopy; Neoadjuvant chemoradiotherapy; Rectal cancer; Short-term outcome; Sphincter-preserving surgery; Total mesorectal excision.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anal Canal / surgery
  • Chemoradiotherapy, Adjuvant / methods*
  • Conversion to Open Surgery
  • Female
  • Humans
  • Intraoperative Complications / diagnosis
  • Laparoscopy / methods*
  • Male
  • Middle Aged
  • Neoadjuvant Therapy
  • Operative Time
  • Postoperative Complications / diagnosis
  • Prospective Studies
  • Rectal Neoplasms / surgery
  • Rectal Neoplasms / therapy*
  • Treatment Outcome