Comparison Of Efficacy Between Laparoscopic And Open Radical Resection For Mid Or Low Rectal Cancer Following Neoadjuvant Chemoradiotherapy

Objective To explore the differences in outcomes between laparoscopic and opensurgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy.Methods164cases of patients with consecutive radical operation for mid or lowrectal cancer after neoadjuvant chemoradiotherapy which are operated by the samesurgical team in General Surgery Department in Fujian Medical University UnionHospital from January2003to December2012. According to the included criteria,155cases left and divided into two groups prospectively and nonrandoml, and receivedlaparoscopic assisted radical surgery(LP,n=102)and open surgery(OP,n=53).9caseswith conversion to open procedure were assigned into open group.The perioperativeclinical outcomes, oncologic outcomes,and long-term outcomes were comparedbetween the groups.Results1. No significant difference was found between the two groups in terms of gender, age,body mass index,cTNM stages,ypTNM stages,past history of abdominal surgery,operation time,operation mode (AR vs. APR),rate of anal sphincter preservation,rateof defunctioning stoma, neoadjuvant chemoradiotherapy or postoperative adjuvantchemotherapy.2. Patients in the laparoscopic surgery group lost less blood than those in the opensurgery group (median50mL [5-1000] vs.100mL [30-600], p<0.001) and bowelfunction returned sooner (2.0days [0-8.0] vs.3.0days [0-6.0]; p<0.05). Surgery timeand postoperative hospital stay did not differ between the two groups.3.The overall rate of postoperative complications was24.5percent in the laparoscopicsurgery group and37.7percent in the open surgery group (P=0.085).But postoperativeintestinal obstruction(LP1.0%vs. OP7.5%,P=0.047) and pulmonary infection (LP 4.9%vs. OP22.6%,P=0.001)in laparoscopic surgery group was significantly lowerthan that in open surgery group.4. The number of harvested lymph nodes and proximal resection margin did not differbetween the two groups.However,distal resection margin was longer in thelaparoscopic group (3cm[2-6] vs.2cm[1-5]; P=0.011).5. No differences were found between laparoscopically assisted and open surgery interms of3-year local recurrence rate (LP1.4%vs. OP8.5%; P=0.167)and3-yeardistant recurrence rate (LP17.9%vs. OP13.5%; P=0.067).6. There was no difference in the3-year OS rate between the two groups (LP88.1%vs. OP91.8%; log rank statistic=1.283, P=0.257)and with no difference in the3-year DFS rate (LP76.9%vs. OP82.1%; log rank statistic=2.107, P=0.147).Conclusion Laparoscopic surgery after preoperative chemoradiotherapy for mid orlow rectal cancer is safe, and is possible to achieve the similar long-term outcomes tothe open procedure．...