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Laparoscopic versus open surgery for rectal cancer after neoadjuvant chemoradiation: a matched case-control study of short-term outcomes

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Abstract

Background

Neoadjuvant chemoradiation (nCRT) currently is commonly incorporated into the multimodal treatment of locally advanced rectal cancers. This study aimed to compare the short-term outcomes and oncologic adequacy of laparoscopic and conventional open surgery for rectal cancer after nCRT.

Methods

A series of 72 patients who underwent laparoscopic surgery (Lap group) for rectal cancer after nCRT were matched for type of surgery, gender, and American Society of Anesthesiologists (ASA) class with 72 patients who underwent conventional surgery during the same time period (Open group). The short-term outcomes were compared between the two groups of patients.

Results

No significant difference was found between the two groups in terms of age, distance of tumor from the anal verge, body mass index, or posttreatment pathologic stage of the disease. There were significant differences between the Lap and Open groups in terms of blood loss (median: 200 vs 400 ml; P < 0.001), duration of surgery (median: 270 vs 240 min; P < 0.001), time to passing of first flatus (median: 2 vs 3 days; P < 0.001), time to start of normal diet (median: 5 vs 6 days; P < 0.001), and hospital stay (median: 12 vs 15 days; P < 0.001). A significant difference in the number of lymph nodes harvested was not identified between the two groups, although more patients in the Open group had a positive circumferential resection margin than in the Lap group (10 vs 1%; P = 0.03). The short-term benefits of laparoscopic surgery also were observed when the 64 patients who underwent abdominoperineal resection (APR) in each of the two groups were compared separately.

Conclusion

Laparoscopic surgery for rectal cancer, especially laparoscopic APR, after nCRT is safe and associated with earlier recovery of bowel function, a shorter hospital stay, and an oncologically adequate specimen compared with conventional open surgery.

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Acknowledgment

We acknowledge the immense help rendered by Mr. M. Sivakumar of the Tumor Registry, Cancer Institute (WIA), Chennai in maintaining the medical records of the patients.

Disclosures

Ramakrishnan Ayloor Seshadri, Ayyappan Srinivasan, RiteshTapkire, and Rajaraman Swaminathan have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgical Oncology, Cancer Institute (WIA), Annexe Campus, No.18, Sardar Patel Road, Guindy, Chennai, 600036, India

    Ramakrishnan Ayloor Seshadri & Ritesh Tapkire

  2. Apollo Speciality Hospitals, 320, Anna Salai, Chennai, 600035, India

    Ayyappan Srinivasan

  3. Department of Biostatistics and Tumor Registry, Cancer Institute (WIA), Annexe Campus, No.18, Sardar Patel road, Guindy, Chennai, 600036, India

    Rajaraman Swaminathan

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  1. Ramakrishnan Ayloor Seshadri
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Correspondence to Ramakrishnan Ayloor Seshadri.

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Seshadri, R.A., Srinivasan, A., Tapkire, R. et al. Laparoscopic versus open surgery for rectal cancer after neoadjuvant chemoradiation: a matched case-control study of short-term outcomes. Surg Endosc 26, 154–161 (2012). https://doi.org/10.1007/s00464-011-1844-5

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