Comparison of tumor recurrence between laparoscopic total mesorectal excision with sphincter preservation and laparoscopic abdominoperineal resection for low rectal cancer
Journal
Surgical Endoscopy
Journal Volume
27
Journal Issue
9
Pages
3452-3464
Date Issued
2013
Author(s)
Abstract
Background: By traditional open surgery, the tumor recurrence rate of total mesorectal excision with sphincter-preserving procedure was lower than that of abdominoperineal resection (APR) for the treatment of low rectal cancer. The present study aimed to rescrutinize whether the same conclusion can be drawn when both surgical procedures are performed laparoscopically. Methods: We retrospectively reviewed the prospectively recorded clinicopathologic data of 344 consecutive patients with low rectal cancer, in which 170 patients underwent preoperative chemoradiotherapy followed by laparoscopic total mesorectal excision (TME), whereas 174 patients underwent laparoscopic TME directly without chemoradiotherapy. Such patients were further stratified according to the pathologic tumor, node, metastasis stage (stage II or III disease) and surgical strategy (APR or sphincter-preserving operation [SPO]). The surgical procedures are presented in supplemental videos. The disease-free survival, recurrence patterns, and functional recovery of patient groups stratified as appropriate were compared. Results: In patients who received preoperative chemoradiotherapy, the estimated recurrence rate were similar between laparoscopic TME with SPO and laparoscopic APR with 10.6 %, 7 of 66, versus 18.5 %, 5 of 27, in stage II disease (p = 0.811, log-rank test); and 19.3 %, 11 of 57, versus 20 %, 4 of 20, in stage III disease (p = 0.980). In patients without preoperative chemoradiotherapy, the recurrence rate was significantly higher in laparoscopic APR than in the laparoscopic TME with SPO group of patients with stage III disease (45 %, 9 of 20, vs. 19.3 %, 16 of 83, p = 0.025), whereas the recurrence rate of the two procedures was similar (21.4 %, 3 of 14, vs. 17.5 %, 10 of 57, p = 0.702) in stage II disease. Conclusions: When low rectal cancer was operated on by laparoscopic approach, the poorer prognosis of APR compared to SPO was only observed in stage III patients without preoperative chemoradiotherapy. ? 2013 Springer Science+Business Media New York.
SDGs
Other Subjects
bevacizumab; carcinoembryonic antigen; fluorouracil; folinic acid; oxaliplatin; tegafur; adult; anastomosis leakage; antigen detection; article; cancer combination chemotherapy; cancer radiotherapy; cancer staging; cerebrovascular accident; controlled study; deep vein thrombosis; disease free survival; drug efficacy; drug safety; female; functional assessment; heart infarction; hematoma; human; human tissue; ileostomy; intermethod comparison; laparoscopic abdominoperineal resection; laparoscopic surgery; laparoscopic total mesorectal excision with sphincter preservation; major clinical study; male; minimally invasive surgery; multiple cycle treatment; outcome assessment; pneumonia; postoperative complication; postoperative hemorrhage; postoperative pain; priority journal; progression free survival; rectum cancer; recurrent cancer; retrospective study; surgical approach; surgical technique; urinary tract infection; urine retention; wound infection; Anal Canal; Chemoradiotherapy; Colonoscopy; Diagnostic Imaging; Female; Humans; Laparoscopy; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Perineum; Rectal Neoplasms; Retrospective Studies; Survival Rate; Treatment Outcome
Publisher
Springer New York LLC
Type
journal article