Laparoscopic versus open surgery for rectal cancer after neoadjuvant chemoradiation: Long‐term outcomes of a propensity score matched study

Seshadri, Ramakrishnan Ayloor; Swaminathan, Rajaraman; Srinivasan, Ayyappan

doi:10.1002/jso.24868

Cited by 13 publications

(7 citation statements)

References 31 publications

(55 reference statements)

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“…Several multicenter randomized controlled trials have compared the efficacy of laparoscopic surgery and open surgery in the treatment of colon/rectal cancer. It is confirmed that laparoscopic surgery can reduce postoperative pain, rapidly restore intestinal function, shorten hospital stay compared with open surgery, and have similar long-term prognosis of tumor, such as overall survival rate and disease-free survival rate (Lujan et al, 2009;Kang et al, 2010a;Jeong et al, 2014c;Seshadri et al, 2018). So, recently laparoscopic surgery for colorectal cancer has become common and widely accepted as a therapeutic option, and laparoscopic resection of rectal cancer may also be an effective treatment for elderly patients (Frasson et al, 2008).…”

Section: Resultsmentioning

confidence: 96%

Outcomes of Laparoscopic Versus Open Surgery in Elderly Patients with Rectal Cancer

Zhang

Liang

Chen

et al. 2021

Asian Pac J Cancer Prev

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Background: Laparoscopic colorectal resection has been gaining popularity over the past two decades-and the number of elderly patients with colorectal cancer treated with a surgical modality has gradually increased. However, studies about laparoscopic rectal surgery in elderly patients with long-term oncologic outcomes are limited. In this study, we evaluated the safety and effectiveness of laparoscopic resection in patients with rectal cancer aged ≥80 y. Methods: From 2007-2015, a total of 84 consecutive patients with rectal cancer from a single institution were included, 45 patients undergoing laparoscopic rectal resection were compared with 39 patients undergoing open rectal resection. Results: The two groups were well balanced in terms of age, gender, body mass index, American society of anesthesiologists scores, previous abdominal surgery, neoadjuvant therapy, tumor stage, distance of tumor from the anal verge, and comorbidities. One (2.2%) patient in the laparoscopic group required conversion to open surgery. Laparoscopic surgery was associated with significantly longer operating time (160.1±28.2 versus 148.2±41.3 min; P=0.031), less intraoperative blood loss (80.5±20.9 versus 160.3±42.4 mL; P=0.002), less need of blood transfusion (6.7% versus 20.5%; P=0.003), a shorter time to diet recovery (2.5±1.5 versus 4.9±1.1; P=0.015) and postoperative hospital stay (7.5±4.5 versus 10.8±4.2; P=0.035), lower overall postoperative complication rate (8.9% versus 20.5%; P=0.017), and wound-related complication rate (4.4% versus 10.2%; P=0.013) when compared with open surgery. Specimen length, no. of retrieced lymph nodes, positive distal and circumferential margin rate, mortality rate, and reoperation rate were not significantly different between two groups. The disease-free and overall 5-year survival rates were similar between two groups.Conclusions: Laparoscopic rectal surgery is safe and feasible in patients aged≥80 y and is associated with similar long-term oncologic outcomes when compared with open surgery.

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Section: Resultsmentioning

confidence: 96%

Outcomes of Laparoscopic Versus Open Surgery in Elderly Patients with Rectal Cancer

Zhang

Liang

Chen

et al. 2021

Asian Pac J Cancer Prev

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“…Moreover, its encouraging shortterm outcomes and the documentation of long-term oncological outcomes comparable to those of open surgery in randomized controlled studies and meta-analyses have eliminated concerns about the oncological outcomes of laparoscopic rectal cancer surgery. [2,8,15,[22][23][24] In a previous large series, Chapman et al [9] evaluated patients that underwent surgery for rectal cancer and found no significant difference between the patients that underwent neoadjuvant chemoradiation followed by surgery and patients that underwent surgery alone with regard to overall morbidity and 30-day mortality. In a meta-analysis that mostly reviewed randomized controlled studies and compared open and laparoscopic surgery, Lu et al [2] suggested that laparoscopy is a safe procedure to be administered after nCRT in patients with middle and lower rectal cancer.…”

Section: Discussionmentioning

confidence: 99%

“…[1,2,[7][8][9][10][11][12][13][14] Additionally, the documentation of long-term oncological outcomes comparable to those of open surgery has eliminated concerns about the oncological outcomes of laparoscopic rectal cancer surgery. [8,15] In the present study, we aimed to investigate the effect of nCRT on perioperative outcomes in patients undergoing laparoscopic rectal cancer surgery.…”

Section: Introductionmentioning

confidence: 99%

Effect of preoperative chemoradiotherapy on perioperative outcomes in patients undergoing laparoscopic rectal cancer surgery

Aday¹

2019

Laparosc Endosc Surg Sci

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Introduction: The aim of this study was to investigate the effect of neoadjuvant chemoradiotherapy (nCRT) on perioperative outcomes in patients who underwent laparoscopic rectal cancer surgery. Materials and Methods: This retrospective study included patients who underwent laparoscopic surgery due to rectal adenocarcinoma between January 2017 and March 2019. Patients who underwent open surgery, transanal excision, or additional resection due to metastasis were excluded from the study. Demographic, clinical, and pathological characteristics of the patients were recorded. Perioperative complications were categorized according to the extended Clavien-Dindo classification. Results: The 61 patients enrolled in the study comprised 35 (57.4%) patients who received nCRT (nCRT group) and 26 (42.6%) patients who did not receive nCRT (non-nCRT group). The mean age was 54.6±12.9 years in the nCRT group and 62±14.8 years in the non-nCRT group, which represented a significant difference between the 2 groups (p=0.048). The groups were similar with regard to comorbidities, body mass index, American Society of Anesthesiologists score, pathological staging, and length of hospital stay. The mean operative time was 298±36.8 minutes in the nCRT group and 243±50.2 minutes in the non-nCRT group, which amounted to a significant difference (p<0.001). The classification of complications indicated Grade I, II, III, and IV complications in 16 (45.7%), 15 (42.8%), 3 (8.6%), and 1 (2.9%) patients, respectively, in the nCRT group as opposed to 16 (61.6%), 8 (30.8%), 1 (3.8%), and 1 (3.8%), respectively, in the non-nCRT group, and no significant difference was found between the 2 groups (p=0.606). Conclusion: The results indicated that nCRT had no effect on perioperative complications and resulted in longer operative times in laparoscopic rectal cancer surgery.

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“…Based on the criteria described in the Methods and Materials section, 17 publications were evaluated with more details, but some did not provide enough details of outcomes by 2 approaches. Therefore, finally 10 studies [7,16,17,[21][22][23][24][25][26][27] were included in this meta-analysis. The search process is described in Figure 1.…”

Section: Literature Search Process and Study Characteristicsmentioning

confidence: 99%

Prognosis Comparisons of Laparoscopy versus Open Surgery for Rectal Cancer Patients after Preoperative Chemoradiotherapy: A Meta-Analysis

Niu

Liu

et al. 2021

Oncol Res Treat

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Aim: We aimed to compare the oncological outcomes of laparoscopy and open resection for patients with rectal cancer following neoadjuvant chemoradiotherapy (NCRT). Methods: We searched the publications that compared the efficacy of laparoscopic surgery and open thoracotomy in treatment outcomes of rectal cancer after NCRT. All trials analyzed the summary hazard ratios of the endpoints of interest, including survival and individual postoperative complications. Results: Totally, 10 trials met our inclusion criteria. The pooled analysis of 3-year disease-free survival (OR 1.39, 95% CI 0.93–2.06; p = 0.11) and 3-year overall survival (OR 1.01, 95% CI 0.70–1.45; p = 0.97) showed that laparoscopic surgery did not achieve beneficial effects compared with open thoracotomy. The pooled result of duration of surgery indicated that laparoscopic surgery was associated with a trend for longer surgery time (SMD 27.53, 95% CI 1.34–53.72; p = 0.04), shorter hospital stay (SMD –1.64, 95% CI –2.70 to –0.58; p = 0.002), more postoperative complications (OR 0.77, 95% CI 0.60–0.99; p = 0.04), and decreased blood loss (SMD –49.87, 95% CI –80.61 to –19.14; p = 0.001). However, the number of removed lymph nodes, positive circumferential resection margin, as well as complications after surgery showed significant differences between the 2 groups. Conclusions: We focused on current evidence and reviewed the studies indicating that similar oncological outcomes were associated with laparoscopic surgery following NCRT for patients with locally advanced lower rectal cancer in comparison with open surgery.

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Laparoscopic versus open surgery for rectal cancer after neoadjuvant chemoradiation: Long‐term outcomes of a propensity score matched study

Abstract: Laparoscopic surgery following NCRT for low and mid third rectal cancers was associated with similar long-term oncological outcomes when compared to open surgery.

Cited by 13 publications

References 31 publications

Outcomes of Laparoscopic Versus Open Surgery in Elderly Patients with Rectal Cancer

Outcomes of Laparoscopic Versus Open Surgery in Elderly Patients with Rectal Cancer

Effect of preoperative chemoradiotherapy on perioperative outcomes in patients undergoing laparoscopic rectal cancer surgery

Prognosis Comparisons of Laparoscopy versus Open Surgery for Rectal Cancer Patients after Preoperative Chemoradiotherapy: A Meta-Analysis

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