title: Postchemoradiation laparoscopic resection and intraoperative electron-beam radiation boost in locally advanced rectal cancer: long-term outcomes.
abstract: BACKGROUND
  In selected patients with rectal cancer, laparoscopic surgery is as safe as open surgery, with similar resection margins and completeness of resection. In addition, recovery is faster after laparoscopic surgery. We analyzed long-term outcomes in a group of patients with locally advanced rectal cancer (LARC) treated with preoperative therapy followed by laparoscopic surgery and intraoperative electron-beam radiotherapy (IOERT).
  
  
  METHODS
  From June 2005 to December 2010, 125 LARC patients were treated with 2 induction courses of FOLFOX-4 (oxaliplatin 85 mg/m(2)/d1, intravenous leucovorin at 200 mg/m(2)/d1-2, and an intravenous bolus of 5-fluorouracil 400 mg/m(2)/d1-2) and preoperative chemoradiation (4,500-5,040 cGy) followed by total mesorectal excision (laparoscopic, 35 %; open surgery, 65 %) and a presacral boost with IOERT.
  
  
  RESULTS
  Patients in the laparoscopic surgery group lost less blood (median 200 vs 350 mL, p < 0.01) and had a shorter hospital stay (7 vs 11 days; p = 0.02) than those in the open surgery group. Laparoscopic procedures were shorter than open surgery procedures (270 vs 302 min; p = 0.67). Postoperative morbidity (32 vs 44 %; p = 0.65), RTOG grade ≥3 acute toxicity (25 vs 25 %; p = 0.97), and RTOG grade ≥3 chronic toxicity (7 vs 9 %; p = 0.48) were similar in the laparoscopy and open surgery groups. The median follow-up time for the entire cohort of patients was 59.5 months (range 7.8-90); no significant differences were observed between the groups in locoregional control (HR 0.91, p = 0.89), disease-free survival (HR 0.80, p = 0.65), and overall survival (HR 0.67, p = 0.52).
  
  
  CONCLUSIONS
  Postchemoradiation laparoscopically assisted IOERT is feasible, with an acceptable risk of postoperative complications, shorter hospital stay, and similar long-term outcomes when compared to the open surgery approach.
authors.affiliation: Department of Oncology, Hospital General Universitario Gregorio Marañon, Ave. Doctor Esquerdo, 46, 28007, Madrid, Spain.
authors.forename: Felipe A
authors.initials: FA
authors.lastname: Calvo
authors.forename: Claudio V
authors.initials: CV
authors.lastname: Sole
authors.forename: Javier
authors.initials: J
authors.lastname: Serrano
authors.forename: Marcos
authors.initials: M
authors.lastname: Rodriguez
authors.forename: Francisco
authors.initials: F
authors.lastname: Marcos
authors.forename: Alberto
authors.initials: A
authors.lastname: Muñoz-Calero
authors.forename: Jaime
authors.initials: J
authors.lastname: Zorrilla
authors.forename: Jose A
authors.initials: JA
authors.lastname: Lopez-Baena
authors.forename: Benjamin
authors.initials: B
authors.lastname: Diaz-Zorita
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: García-Sabrido
authors.forename: Emilio
authors.initials: E
authors.lastname: del Valle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D007391:International Cooperation; D007430:Intraoperative Care; D010535:Laparoscopy; D002955:Leucovorin / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000009:adverse effects; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D012004:Rectal Neoplasms / Q000473:pathology / Q000628:therapy*
chemical_list: D009944:Organoplatinum Compounds; D002955:Leucovorin; D005472:Fluorouracil