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Short- and long-term outcomes of laparoscopic versus open pelvic exenteration for locally advanced rectal cancer: a single-center propensity score matching analysis

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Abstract

Background

Research on short-term outcomes and long-term oncological results of laparoscopic pelvic exenteration (LPE) for locally advanced rectal cancer (LARC) is still limited. The purpose of this study was to compare the outcomes of LPE and open pelvic exenteration (OPE).

Methods

Between January 2010 and December 2019, consecutive LARC patients who underwent radical pelvic exenteration at Peking University First Hospital were enrolled. Groups were matched at a 1:1 ratio using propensity score matching. The primary endpoints were 3 year overall survival (OS) and disease-free survival (DFS). The secondary endpoints were postoperative short-term outcomes.

Results

There were 144 patients (68 males and 76 females, median age 58.5 [range 27.0–86.0] years). After matching, patients were stratified into LPE (n = 48) and OPE (n = 48) groups (LPE: 24 males and 24 females, median age 57.0 [range 27.0-81.0] years; OPE: 26 males and 22 females, median age 58.0[range 36.0-80.0] years). There were no significant differences on baseline data between the two groups. Compared with the OPE group, the LPE group had a significantly lower estimated blood loss (200 vs 500 ml, p = 0.003), less overall postoperative complications (12/48 vs 25/48, p = 0.006), less surgical site infection (8/48 vs 20/48, p = 0.007), shorter length of stay (12 vs. 15 days, p = 0.005), but similar operative time (344 vs. 360 min, p = 0.493). The pathological R0 resection rate (98.0% vs. 93.7%, p = 0.610), 3 year local recurrence (18.4% vs. 23.5, p = 0.140), 3 year OS (74.6% vs. 65.5%, p = 0.290) and 3-year DFS (60.0% vs. 50.3%, p = 0.208) were similar between the two groups. Shorter distance from anal verge (HR = 0.92, p = 0.042), (y) pT4b (HR = 2.45, p = 0.023), (y)pN1-2 (HR = 2.42, p = 0.004) and positive CRM (HR = 6.23, p = 0.004) were independent prognostic risks for 3 year DFS.

Conclusions

LPE can be performed safely and has certain short-term advantages over OPE, most notably less blood loss and surgical site infection. However, LPE does not improve long-term oncological outcomes.

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Funding

This study was supported by grants from the National Natural Science Foundation of China (No. 81272710) and Wu Jieping’s Foundation Special for Clinical Research (No. 320.6750.2021–04-02).

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Authors and Affiliations

  1. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China

    J. Tang

  2. Department of General Surgery, Peking University First Hospital, Beijing, China

    J. Tang, J. Liu, J. Zhang, X. Wang & Y. Wan

  3. Department of Colorectal Surgery, Gansu Provincial Hospital, Lanzhou, 100034, China

    B. Du

  4. Department of General Surgery, The Third People’s Hospital of Datong, Datong, 037046, China

    L. Zheng

  5. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital, Chinese Academy of Medical Sciences, Langfang, 065001, China

    J. Tang

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Correspondence to J. Tang or X. Wang.

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Conflict of interest

Dr Jianqiang Tang, Junguang Liu, Binbin Du, Junling Zhang, Lijun Zheng, Xin Wang, and Yuanlian Wan have no conflict of interest or financial ties to disclose.

Ethical approval

All work was carried out in compliance with the Ethical Principles for Medical Research Involving Human Subjects outlined in the Helsinki Declaration in 1975 (revised in 2000).

Informed consent

All patients enrolled provided written informed consent, and this study was approved by Peking University First Hospital ethics committee of biomedical research (2021–351).

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Tang, J., Liu, J., Du, B. et al. Short- and long-term outcomes of laparoscopic versus open pelvic exenteration for locally advanced rectal cancer: a single-center propensity score matching analysis. Tech Coloproctol 27, 43–52 (2023). https://doi.org/10.1007/s10151-022-02691-0

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  • DOI: https://doi.org/10.1007/s10151-022-02691-0

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