Prognostic Comparison Of Local Recurrence Between Laparoscopic And Open Radical Resection For Colorectal Cancer

Purpose:Comparing the different prognosis of local recurrence between laparoscopic and open radical resection for colorectal cancer, so as to know the safety of laparoscopic colorectal surgery. Also comparing and summarizing our diagnostic and therapeutic practices to promote the level of diagnosis and therapy for local recurrence of colorectal cancer.Method: From September 2000 to December 2005,297 cases with colorectal cancer were divided into two groups prospectively and nonrandomly, and received laparoscopic radical surgery(LP,n=99) and open surgery(OP,n=198).The rate and prognosis of local recurrence were compared between the two groups.Results: 2-year,3-year and overall locally recurrent rate were the same 3.03 percent(3/99) in LP group, and 2.62 percent,4.04 percent,3.54 percent respectively in OP group(7/198).All local recurrences of the two groups occurred in the first 3-years'follow-up. The variation of locally recurrent rate between the two groups achieved no statistical significance(P>0.05).The influent factors of local recurrence were different between LP and OP group: gender, age(up or under 65 years old), location of primary tumor(colon or rectum), lymphatic metastasis and invasive depth of intestine of colorectal cancer were not influent factors of local recurrence and malignant degree(histological type and differentiating degree) was the only influent factor in LP group(P=0.013). Gender, age, location of primary tumor and invasive depth of intestine of colorectal cancer were not influent factors of local recurrence in OP group too. Differently malignant degree(upper or lower) besides lymphatic metastasis were influent factors in OP group(P=0.000 and P=0.017 respectively). The prognostic variation of local recurrence between the two groups had no statistical significance: LP and OP group had their median survival respectively 15 months(7-24 months) and 11months(2-28 months). The variation of median survival between the two groups had no statistical significance(P>0.05).LP group showed 1-year and 2-year survival rate of 33.3 percent and 0 percent respectively of local recurrence. OP group showed the same 1-year and 2-year survival rate of 42.9 percent of local recurrence. The variation of the survival rate between the two groups had no statistical significance(P>0.05). The variation of diagnostic way of local recurrence between LP and OP group had no statistical significance(P>0.05): all 3 cases of local recurrence in LP group were diagnosed by clinical symptoms of the patients. At the time 1 of the 3 cases had had liver metastasis(1/3). And 6 of the 7 cases of local recurrence of colorectal cancer in OP group were diagnosed by clinical symptoms of the patients. Only 1 of the 7 cases was diagnosed by rising of CEA and CA-199 asymptomatically. At the time 3 of the 7 cases had had liver or lung metastasis(3/7). The therapeutic way of local recurrence between LP and OP group had no statistical significance too(P>0.05): all 3 cases of locally recurrent rectal cancer in LP group received chemoradiotherapy or enterostomy simultaneously(2 of them were located on the latter of the pelvic wall). Resection rate was 0 percent in LP group(0/3). There were 2 cases of local recurrence of colon cancer in OP group, and 1 case received R0 resection(have survived 27 months up to now) and another case received chemoradiotherapy. All 5 cases of local recurrence of rectal cancer received chemoradiotherapy(all were located on the latter of the pelvic wall). Total resection rate was 14.3 percent in OP group(1/7).Conclusion: Laparoscopic surgery for colorectal cancer is safety and it didn't increase the risk of local recurrence, contrarily it is possible to reduce local recurrence of colorectal cancer that had lymphatic metastasis. The prognosis of locally recurrent colorectal cancer had no obvious variation between LP and OP group, and it was associated with if diagnosis of local recurrence was early or not, the location of locally recurrent colorectal cancer and whether locally recurrent colorectal cancer was resected.