Short-term efficacy analysis and comprehensive evaluation of laparoscopy for patients with rectal cancer-a prospective multi-center study

Abstract

Objective To compare the short-term efficacy indicators of laparoscopic technique and open surgery in patients with rectal cancer surgery, and to further evaluate the safety and efficacy of laparoscopic rectal cancer surgery. Methods This study adopted a prospective multicenter, open-label, non-randomized concurrent control method to analyze patients who received rectal cancer surgery from 10 colorectal tumor centers across the country from January 2017 to December 2018. The two groups of patients received laparoscopic-assisted surgery and conventional open surgery respectively. All surgeons were selected according to relevant standards and participated in the two groups of operations at the same time. Comprehensive evaluation and analysis of the operation and postoperative recovery, postoperative pathological results, survival information, postoperative related functional scores and other indicators. Results In the open surgery group, the proportion of tumors with a maximum diameter of more than 5 cm was higher (χ2 = 0.089, P = 0.018), and the proportion of T4 was higher (χ2 = 0.478, P < 0.001). In the laparoscopic group, the proportion of more than 12 harvested lymph nodes was higher (χ2 = 0.248, P < 0.001). There were no significant differences in the length of postoperative hospital stay, intraoperative blood loss, time to first flatus after operation, time to first out of bed, time to first liquid diet, and preservation rate of anal sphincter between the two groups, but in the laparoscopic surgery group the operation time was shorter (t = 6.750, P < 0.001) and postoperative pain was less (t = 0.896, 0.63, 0.964, and 0.989 on postoperative days 1, 2, and 3, respectively, all P < 0.001). The incidence of grade 2–4 adverse complication in the two groups was 12.5% and 14.6%, respectively, with no statistical difference (χ2 = 0.061, P = 0.105), but the incidence of incision infection was lower in the laparoscopy group (χ2 = 0.19, P < 0.001). There was no significant difference in 3-year disease-free survival between the two groups (HR = 1.089, 95% CI = 0.962–1.232, P = 0.170). Multivariate analysis suggested that intraoperative blood loss, T stage, N stage, nerve invasion, and postoperative sepsis were independent prognostic factors for disease-free survival. Wexner score, IPSS score and LARS score were not statistically different between the two groups. Conclusion The pathological results and short-term outcomes of laparoscopic surgery for rectal cancer are comparable to those of conventional open surgery, and laparoscopic surgery is safe and feasible for rectal cancer patients.