Comparison Of The Clinical Efficacy Between Laparoscopic And Open Surgery For Rectal Cancer

Background:With the improvement of people’s living standards and lifestyle changes, the incidence of gastrointestinal tumors also tends to go up. The prevalence of rectal cancer showed a small range of high-fat trend, which morbidity increased year by year. In recent years, scholars believe that certain aspects of the laparoscopic technique for the treatment of colon cancer than traditional surgery, it is no evidence in advantage of laparoscopic surgery for colorectal cancer, especially on long-term outcomes of laparoscopic colorectal cancer resection is still a lack of reliable data. Therefore, we reviewed that clinical outcomes of surgical treatment for patients with rectal cancer in our hospital several years ago, in order to provide a theoretical basis for further confirm the clinical efficacy of laparoscopic treatment for rectal cancer.Objective:In order to investigate the perioperative outcome and 3-year clinical outcome after laparoscopic surgery in patients with rectal cancer, and the influence of the clinical outcome in rectal cancer patients with laparoscopic surgery conversion to open surgery.Methods:The screening of patients were divided into two groups according to the surgical screening criteria, there were respectively open surgery group, laparoscopic surgery group, in which laparoscopic surgery group was divided into complete laparoscopic surgery group and conversion to open surgery group. The primary outcomes were the perioperative outcome and 3-year clinical outcome after laparoscopic surgery.Results:1. In the intention of laparoscopic surgery group,28 (23.14%) patients required conversion to open surgery.2. There were no significant differences in the clinical data such as age, gender, body mass index (BMI), the American Society of Anesthesiologists (ASA) score and preoperative CEA level, and tumor characteristics, such as tumor stage, lymph node status, tumor distance from the anal covered wire, tumor radius and surgical procedure between intended for laparoscopic treatment group and open surgery group (P> 0.05). However, the patients in the converted group were older (P<0.05).3. The postoperative 30 d mortality and morbidity rates were similar in all the groups, the overall mortality rate was 1.63%. The intraoperative blood loss in laparoscopic surgery group was significantly lower than the other two groups (P<0.05), and the hospital stay and first bowel movement were significantly shorter (P<0.05). Fewer wound infections were observed in the laparoscopic surgery group than in the open surgery group or the converted surgery group (P<0.05), but anastomotic leakage appeared to be higher in the conversion group than in the other groups, but the difference did not reach statistical significance (P> 0.05).4. The rate of R0 resections and the number of harvested lymph nodes did not differ between the three groups (P>0.05). The 3 year overall survival (P=0.414) and Disease-free survival rate(P=0.245) for all the patients did not differ significantly between the two groups (P>0.05). The local recurrence and distant metastasis rate during the observation period was lower in the laparoscopic group, but the difference did not reach statistical significance (P>0.05). Univariate analysis revealed that tumor distance from the anal margin (1-5 cm) as the only significant factor in terms of Disease-free survival.Conclusion:1. Laparoscopic rectal cancer surgery could improve perioperative outcomes, and does not worsen the 3-year clinical outcome.2. The conversion in minimally invasive rectal cancer resection does not lead to higher rates of morbidity and mortality, and does not worsen the clinical outcome.