title: Laparoscopy in the surgical treatment of rectal cancer in Germany 2000-2009.
abstract: OBJECTIVE
  The goal of this registry study was to compare open surgery with planned laparoscopy and then with laparoscopic to open conversion for rectal cancer surgery.
  
  
  METHODS
  The study included 17,964 rectal cancer patients, operated on between 1 January 2000 and 31 December 2009, from 345 hospitals in Germany. All statistical tests were two-sided, with the χ(2) test (Pearson correlation) for patients and tumour characteristics. Fisher's exact test was used for complications and 30-day mortality.
  
  
  RESULTS
  Of the 17,964 rectal cancer patients, 16,308 (90.8%) had an open procedure and 1656 (9.2%) were started with a laparoscopy. The 1455 patients with completed laparoscopic operations had fewer intra-operative and postoperative complications (5.4%vs 7.0%, P = 0.020, and 20.5%vs 25.8%, P < 0.001, respectively) and a lower 30-day mortality rate (1.1%vs 1.9%, P = 0.023). Of the 1656 planned laparoscopies, 201 (12.1%) were converted to open. The converted group suffered more intra-operative complications (18.9%vs 3.6% for completed laparoscopy and 7.0% for open surgery, P < 0.0001) and postoperative complications (32.3%vs 18.9% for completed laparoscopy and 25.8% for open operations, P < 0.0001). The converted group also had a higher 30-day mortality rate (2.0%vs 1.0% for completed laparoscopy and 1.9% for open surgery, P = 0.043).
  
  
  CONCLUSIONS
  The more favourable patient profile provided justification for a laparoscopic procedure. For those converted to an open procedure, however, there were significantly more complications than planned open surgery patients. A move away from the standard open procedure for rectal cancer surgery and towards laparoscopy is not yet feasible.
authors.affiliation: Department of General, Visceral and Vascular Surgery, Otto-von-Guericke University of Magdeburg, Germany. pawel.mroczkowski@med.ovgu.de
authors.forename: P
authors.initials: P
authors.lastname: Mroczkowski
authors.forename: S
authors.initials: S
authors.lastname: Hac
authors.forename: B
authors.initials: B
authors.lastname: Smith
authors.forename: U
authors.initials: U
authors.lastname: Schmidt
authors.forename: H
authors.initials: H
authors.lastname: Lippert
authors.forename: R
authors.initials: R
authors.lastname: Kube
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D010535:Laparoscopy; D008297:Male; D061646:Operative Time; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies