Short-term And Long-term Outcomes Of Laparoscopic Radical Resection And Traditional Open Surgery For Rectal Cancer

Part 1 Short-term outcomes of laparoscopic radical resection and traditional open surgery for rectal cancerObjective To explore the short-term outcomes of laparoscopic versus open surgery for rectal cancer and to explore the feasibility of laparoscopic surgery in the treatment of rectal cancer in primary hospital.Method In this retrospective study,383 patients who underwent laparoscopic or open surgery for rectal cancer from January 2009 to September 2017 in the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture were evaluated.There were286 cases underwent laparoscopic radical resection(LRR group)and the rest of 97patients underwent open surgery(ORR group).The preoperative,intraoperative and postoperative parameters and complications were observed and analyzed.Results There was no significant difference in sex composition,age and occupation before operation between the two groups(P>0.05).In the laparoscopic group,13 cases(4.35%)were converted to open surgery.The operation time of laparoscopic group and open group were(166.68±37.286)min vs(162.62±50.569)min.There was no significant difference between the two groups(t=0.673,P=0.502).The amount of bleeding in laparoscopic group was less than that in open group,which were(158.30±108.667)ml vs(232.06±145.150)ml.The difference was statistically significant(t=-5.279,P<0.001).There was no complications occurred during operation in both groups.Postoperative pathological examination showed that the positive rate of circumferential margin was 0.7%in laparoscopic group and no positive circumferential margin was found in the open group.No statistically significant difference was found(x~2<0.001,P=0.992).The detection rate of lymph nodes in laparoscopic group was higher than that in open group(14.98±4.270)vs(13.95±2.949).The difference was statistically significant(t=2.197,P=0.029).The hospitalization days and the first time to eat in laparoscopic group were shorter than those in open group,and the difference was statistically significant(P<0.05).The first anal exhaust time of the two groups were(4.76±2.016)days and(5.06±1.886)days.There was no significant difference between the two groups(t=-1.300,P=0.194).Postoperative blood transfusion rate in open group was significantly higher than that in laparoscopy group(x~2=61.882,P<0.05).Conclusion Laparoscopic radical resection for rectal cancer is effective and safety.It can reduce intraoperative bleeding,shorten hospital stay and intestinal function recovery time,and without increasing the operation time and the incidence of intraoperative and postoperative complications when compared with the open surgery.Part 2 Long-term outcomes of laparoscopic radical resection and traditional open surgery for rectal cancerObjective To explore whether laparoscopic radical resection for rectal cancer has the same long-term effect as traditional open surgery.Method Retrospective study.268 patients who underwent laparoscopic or open surgery for rectal cancer from January 2009 to December 2015 in the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture were evaluated.The patients were divided into laparoscopic surgery group(LRR group,175 cases)and open surgery group(ORR group,93 cases).Disease-free survival rate,total survival rate and local recurrence rate after 3-year in both groups were observed and analyzed.Results There was no significant difference in sex composition,age and preoperative baseline level between the two groups(P > 0.05).With 3-year follow-up,there were 9 cases of local recurrence in laparoscopic group,the local recurrence rate was 5.5%,and 7 cases of local recurrence in open surgery group,the local recurrence rate was 8.0%.There was no significant difference between the two groups(x2 =0.623,P = 0.430).The disease-free survival rate of laparoscopic group was 73.8%(95% [CI 67.92%-79.68%])and open surgery group was 74.4%(95% CI [64.6%-84.2%]).No significant difference was observed between the two groups(x2 = 0.029,P = 0.865).The overall survival rate of laparoscopic group was 83.5%(95% CI[77.62%-89.38%])and open surgery group was 81.4%(95% CI [73.56%-89.23%]).The difference was no significant(x2 = 0.237,P = 0.626).Conclusion Laparoscopic radical resection for rectal cancer has the same long-term effect as open surgery,including disease-free survival rate,overall survival rate and local recurrence rate.