Multicentre propensity score-matched analysis of laparoscopic versus open surgery for T4 rectal cancer

Nicola De’Angelis, Filippo Landi, Giulio Cesare Vitali, Riccardo Memeo, Aleix Martínez-Pérez, Alejandro Solis, Michela Assalino, Francesc Vallribera, Henry Alexis Mercoli, Jacques Marescaux, Didier Mutter, Frédéric Ris, Eloy Espin, Francesco Brunetti

Research output: Contribution to journalArticle

Abstract

Background: The use of laparoscopy for advanced-stage rectal cancer remains controversial. This study aimed to compare the operative and oncologic outcomes of laparoscopic (LAR) versus open anterior rectal resection (OAR) for patients with pT4 rectal cancer. Methods: This is a multicenter propensity score matching (PSM) study of patients undergoing elective curative-intent LAR or OAR for pT4 rectal cancer (TNM stage II/III/IV) between 2005 and 2015. Results: In total, 137 patients were included in the analysis. After PSM, demographic, clinical and tumor characteristics were similar between the 52 LAR and the 52 OAR patients. Overall, 52 tumors were located in the high rectum, 25 in the mid-rectum and 27 in the low rectum. Multivisceral resection was performed in 26.9% of LAR and 30.8% of OAR patients (p = 0.829). Conversion was required in 11 LAR patients (21.2%). The LAR group showed significantly shorter time to flatus (3.13 vs. 4.97 days, p = 0.001), time to regular diet (3.59 vs. 6.36 days, p < 0.0001) and hospital stay (15.49 vs. 17.96 days, p = 0.002) compared to the OAR group. The 90-day morbidity and mortality were not different between groups. In the majority of patients (85.6%), R0 resection was achieved. A complete mesorectal excision was obtained in 82.7% of LAR and 78.8% of OAR patients (p = 0.855). The 1-, 2- and 3-year overall survival rates were, respectively, 95.6, 73.8 and 66.7% for the LAR group and 86.7, 66.9 and 64.1% for the OAR group (p = 0.219). The presence of synchronous metastases (hazard ratio 2.26), R1 resection (HR 2.71) and lymph node involvement (HR 2.24) were significant predictors of overall survival. Conclusion: The present study suggests that LAR for pT4 rectal cancer can achieve good pathologic and oncologic outcomes similar to open surgery despite the risk of conversion. Moreover, laparoscopy offers the benefits of a faster recovery and a shorter hospital stay.

Original languageEnglish
Pages (from-to)1-16
Number of pages16
JournalSurgical Endoscopy and Other Interventional Techniques
DOIs
Publication statusAccepted/In press - Nov 8 2016

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Propensity Score
Rectal Neoplasms
Rectum
Laparoscopy
Length of Stay
Flatulence
Neoplasms
Survival Rate
Lymph Nodes
Demography
Neoplasm Metastasis
Diet
Morbidity
Survival
Mortality

Keywords

  • Laparoscopy
  • Locally advanced rectal cancer
  • Open surgery
  • Propensity score matching
  • Radiochemotherapy
  • Rectal cancer

ASJC Scopus subject areas

  • Surgery

Cite this

De’Angelis, N., Landi, F., Vitali, G. C., Memeo, R., Martínez-Pérez, A., Solis, A., ... Brunetti, F. (Accepted/In press). Multicentre propensity score-matched analysis of laparoscopic versus open surgery for T4 rectal cancer. Surgical Endoscopy and Other Interventional Techniques, 1-16. https://doi.org/10.1007/s00464-016-5332-9

Multicentre propensity score-matched analysis of laparoscopic versus open surgery for T4 rectal cancer. / De’Angelis, Nicola; Landi, Filippo; Vitali, Giulio Cesare; Memeo, Riccardo; Martínez-Pérez, Aleix; Solis, Alejandro; Assalino, Michela; Vallribera, Francesc; Mercoli, Henry Alexis; Marescaux, Jacques; Mutter, Didier; Ris, Frédéric; Espin, Eloy; Brunetti, Francesco.

In: Surgical Endoscopy and Other Interventional Techniques, 08.11.2016, p. 1-16.

Research output: Contribution to journalArticle

De’Angelis, N, Landi, F, Vitali, GC, Memeo, R, Martínez-Pérez, A, Solis, A, Assalino, M, Vallribera, F, Mercoli, HA, Marescaux, J, Mutter, D, Ris, F, Espin, E & Brunetti, F 2016, 'Multicentre propensity score-matched analysis of laparoscopic versus open surgery for T4 rectal cancer', Surgical Endoscopy and Other Interventional Techniques, pp. 1-16. https://doi.org/10.1007/s00464-016-5332-9
De’Angelis, Nicola ; Landi, Filippo ; Vitali, Giulio Cesare ; Memeo, Riccardo ; Martínez-Pérez, Aleix ; Solis, Alejandro ; Assalino, Michela ; Vallribera, Francesc ; Mercoli, Henry Alexis ; Marescaux, Jacques ; Mutter, Didier ; Ris, Frédéric ; Espin, Eloy ; Brunetti, Francesco. / Multicentre propensity score-matched analysis of laparoscopic versus open surgery for T4 rectal cancer. In: Surgical Endoscopy and Other Interventional Techniques. 2016 ; pp. 1-16.
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title = "Multicentre propensity score-matched analysis of laparoscopic versus open surgery for T4 rectal cancer",
abstract = "Background: The use of laparoscopy for advanced-stage rectal cancer remains controversial. This study aimed to compare the operative and oncologic outcomes of laparoscopic (LAR) versus open anterior rectal resection (OAR) for patients with pT4 rectal cancer. Methods: This is a multicenter propensity score matching (PSM) study of patients undergoing elective curative-intent LAR or OAR for pT4 rectal cancer (TNM stage II/III/IV) between 2005 and 2015. Results: In total, 137 patients were included in the analysis. After PSM, demographic, clinical and tumor characteristics were similar between the 52 LAR and the 52 OAR patients. Overall, 52 tumors were located in the high rectum, 25 in the mid-rectum and 27 in the low rectum. Multivisceral resection was performed in 26.9{\%} of LAR and 30.8{\%} of OAR patients (p = 0.829). Conversion was required in 11 LAR patients (21.2{\%}). The LAR group showed significantly shorter time to flatus (3.13 vs. 4.97 days, p = 0.001), time to regular diet (3.59 vs. 6.36 days, p < 0.0001) and hospital stay (15.49 vs. 17.96 days, p = 0.002) compared to the OAR group. The 90-day morbidity and mortality were not different between groups. In the majority of patients (85.6{\%}), R0 resection was achieved. A complete mesorectal excision was obtained in 82.7{\%} of LAR and 78.8{\%} of OAR patients (p = 0.855). The 1-, 2- and 3-year overall survival rates were, respectively, 95.6, 73.8 and 66.7{\%} for the LAR group and 86.7, 66.9 and 64.1{\%} for the OAR group (p = 0.219). The presence of synchronous metastases (hazard ratio 2.26), R1 resection (HR 2.71) and lymph node involvement (HR 2.24) were significant predictors of overall survival. Conclusion: The present study suggests that LAR for pT4 rectal cancer can achieve good pathologic and oncologic outcomes similar to open surgery despite the risk of conversion. Moreover, laparoscopy offers the benefits of a faster recovery and a shorter hospital stay.",
keywords = "Laparoscopy, Locally advanced rectal cancer, Open surgery, Propensity score matching, Radiochemotherapy, Rectal cancer",
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T1 - Multicentre propensity score-matched analysis of laparoscopic versus open surgery for T4 rectal cancer

AU - De’Angelis, Nicola

AU - Landi, Filippo

AU - Vitali, Giulio Cesare

AU - Memeo, Riccardo

AU - Martínez-Pérez, Aleix

AU - Solis, Alejandro

AU - Assalino, Michela

AU - Vallribera, Francesc

AU - Mercoli, Henry Alexis

AU - Marescaux, Jacques

AU - Mutter, Didier

AU - Ris, Frédéric

AU - Espin, Eloy

AU - Brunetti, Francesco

PY - 2016/11/8

Y1 - 2016/11/8

N2 - Background: The use of laparoscopy for advanced-stage rectal cancer remains controversial. This study aimed to compare the operative and oncologic outcomes of laparoscopic (LAR) versus open anterior rectal resection (OAR) for patients with pT4 rectal cancer. Methods: This is a multicenter propensity score matching (PSM) study of patients undergoing elective curative-intent LAR or OAR for pT4 rectal cancer (TNM stage II/III/IV) between 2005 and 2015. Results: In total, 137 patients were included in the analysis. After PSM, demographic, clinical and tumor characteristics were similar between the 52 LAR and the 52 OAR patients. Overall, 52 tumors were located in the high rectum, 25 in the mid-rectum and 27 in the low rectum. Multivisceral resection was performed in 26.9% of LAR and 30.8% of OAR patients (p = 0.829). Conversion was required in 11 LAR patients (21.2%). The LAR group showed significantly shorter time to flatus (3.13 vs. 4.97 days, p = 0.001), time to regular diet (3.59 vs. 6.36 days, p < 0.0001) and hospital stay (15.49 vs. 17.96 days, p = 0.002) compared to the OAR group. The 90-day morbidity and mortality were not different between groups. In the majority of patients (85.6%), R0 resection was achieved. A complete mesorectal excision was obtained in 82.7% of LAR and 78.8% of OAR patients (p = 0.855). The 1-, 2- and 3-year overall survival rates were, respectively, 95.6, 73.8 and 66.7% for the LAR group and 86.7, 66.9 and 64.1% for the OAR group (p = 0.219). The presence of synchronous metastases (hazard ratio 2.26), R1 resection (HR 2.71) and lymph node involvement (HR 2.24) were significant predictors of overall survival. Conclusion: The present study suggests that LAR for pT4 rectal cancer can achieve good pathologic and oncologic outcomes similar to open surgery despite the risk of conversion. Moreover, laparoscopy offers the benefits of a faster recovery and a shorter hospital stay.

AB - Background: The use of laparoscopy for advanced-stage rectal cancer remains controversial. This study aimed to compare the operative and oncologic outcomes of laparoscopic (LAR) versus open anterior rectal resection (OAR) for patients with pT4 rectal cancer. Methods: This is a multicenter propensity score matching (PSM) study of patients undergoing elective curative-intent LAR or OAR for pT4 rectal cancer (TNM stage II/III/IV) between 2005 and 2015. Results: In total, 137 patients were included in the analysis. After PSM, demographic, clinical and tumor characteristics were similar between the 52 LAR and the 52 OAR patients. Overall, 52 tumors were located in the high rectum, 25 in the mid-rectum and 27 in the low rectum. Multivisceral resection was performed in 26.9% of LAR and 30.8% of OAR patients (p = 0.829). Conversion was required in 11 LAR patients (21.2%). The LAR group showed significantly shorter time to flatus (3.13 vs. 4.97 days, p = 0.001), time to regular diet (3.59 vs. 6.36 days, p < 0.0001) and hospital stay (15.49 vs. 17.96 days, p = 0.002) compared to the OAR group. The 90-day morbidity and mortality were not different between groups. In the majority of patients (85.6%), R0 resection was achieved. A complete mesorectal excision was obtained in 82.7% of LAR and 78.8% of OAR patients (p = 0.855). The 1-, 2- and 3-year overall survival rates were, respectively, 95.6, 73.8 and 66.7% for the LAR group and 86.7, 66.9 and 64.1% for the OAR group (p = 0.219). The presence of synchronous metastases (hazard ratio 2.26), R1 resection (HR 2.71) and lymph node involvement (HR 2.24) were significant predictors of overall survival. Conclusion: The present study suggests that LAR for pT4 rectal cancer can achieve good pathologic and oncologic outcomes similar to open surgery despite the risk of conversion. Moreover, laparoscopy offers the benefits of a faster recovery and a shorter hospital stay.

KW - Laparoscopy

KW - Locally advanced rectal cancer

KW - Open surgery

KW - Propensity score matching

KW - Radiochemotherapy

KW - Rectal cancer

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