Results of laparoscopic versus open resections for non-early rectal cancer in patients with a minimum follow-up of four years.
OBJECTIVE
Laparoscopic rectal resection for malignancy is still debated. Concern has been expressed regarding the lack of significant data from larger patient series with longer periods of follow-up. The aims of this study were to compare long-term outcome with a minimum follow-up of four years in unselected patients undergoing either laparoscopic rectal resection or open rectal resection for cancer.


METHODS
From May 1992 to August 1997 all electively admitted patients with rectal cancer were included in a prospective non-randomized study. Written information was submitted to each patient and the location in each group (laparoscopic or open) was related to the patient's choice. The inclusion protocol criteria excluded T1 tumors. All 68 T2-T4 patients underwent preoperative radiotherapy (5.040 cGy), completed with chemotherapy in selected cases (patients below 70 years of age). Long-term results were compared between the two groups. Follow-up time of both groups ranged between 48 and 96 months (mean, 49.4 months).


RESULTS
Excluding patients who underwent a palliative resection or conversion to open surgery and deaths not related to cancer, 53 pts (29 laparoscopic rectal resection, 24 open rectal resection) out of 68 are available and are the object of this study. No patient was lost to follow-up. No wound recurrence was observed. The local recurrence rate after laparoscopic rectal resection was 24.1% vs. 25% after open rectal resection (P = 0.799). Distant metastases occurred in 20.7% of patients in the LLR group (laparoscopic rectal resection) vs. 25% in the ORR group (open rectal resection) (P = 0.980). Cumulative survival probability after laparoscopic rectal resection and open rectal resection was 0.690 and 0.625 (P = 0.492), respectively. Cumulative survival probability for Duke's stage A, B and C in the LRR group vs. the ORR group was 1.000 vs. 0.900 (P = 0.585), 0.667 vs. 0.636 (P = 0.496) and 0.429 vs. 0.445 (P = 0.501), respectively. Sixteen laparoscopic rectal resection patients (55.2%) and 12 open rectal resection patients (50%) are presently disease free (P = 0.979).


CONCLUSIONS
Long-term results after laparoscopic resection of rectal cancer were comparable to those after conventional resection, with a trend in favor of the laparoscopic approach that does not reach a statistically significant difference, possibly due to the limited size of the sample.
Lezoche
Emanuele
E
Department of Surgery Paride Stefanini II, Clinica Chirurgica, University La Sapienza, Viale del Policlinico, 00161 Rome, Italy. lezoche@uniroma1.it
Feliciotti
Francesco
F
Paganini
Alessandro M
AM
Guerrieri
Mario
M
De Sanctis
Angelo
A
Campagnacci
Roberto
R
D'Ambrosio
Gianfranco
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis