title: A comparison of laparoscopic and open surgery following pre-operative chemoradiation therapy for locally advanced lower rectal cancer.
abstract: OBJECTIVE
  Although pre-operative chemoradiation therapy for advanced lower rectal cancer is a controversial treatment modality, it is increasingly used in combination with surgery. Few studies have considered the combination of chemoradiation therapy followed by laparoscopic surgery for locally advanced lower rectal cancer; therefore, this study aimed to assess the usefulness of this therapeutic combination.
  
  
  METHODS
  We retrospectively reviewed the medical records of patients with locally advanced lower rectal cancer treated by pre-operative chemoradiation therapy and surgery from February 2002 to November 2012 at Oita University. We divided patients into an open surgery group and a laparoscopic surgery group and evaluated various parameters by univariate and multivariate analyses.
  
  
  RESULTS
  In total, 33 patients were enrolled (open surgery group, n = 14; laparoscopic surgery group, n = 19). Univariate analysis revealed that compared with the open surgery group, operative time was significantly longer, whereas intra--operative blood loss and intra-operative blood transfusion requirements were significantly less in the laparoscopic surgery group. There were no significant differences in post-operative complication and recurrence rates between the two groups. According to multivariate analysis, operative time and intra-operative blood loss were significant predictors of outcome in the laparoscopic surgery group.
  
  
  CONCLUSIONS
  This study suggests that laparoscopic surgery after chemoradiation therapy for locally advanced lower rectal cancer is a safe procedure. Further prospective investigation of the long-term oncological outcomes of laparoscopic surgery after chemoradiation therapy for locally advanced lower rectal cancer is required to confirm the advantages of laparoscopic surgery over open surgery.
authors.affiliation: *Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita 879-5593, Japan. inomata@oita-u.ac.jp.
authors.forename: Toru
authors.initials: T
authors.lastname: Kusano
authors.forename: Masafumi
authors.initials: M
authors.lastname: Inomata
authors.forename: Takahiro
authors.initials: T
authors.lastname: Hiratsuka
authors.forename: Tomonori
authors.initials: T
authors.lastname: Akagi
authors.forename: Yoshitake
authors.initials: Y
authors.lastname: Ueda
authors.forename: Manabu
authors.initials: M
authors.lastname: Tojigamori
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Shiroshita
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Etoh
authors.forename: Norio
authors.initials: N
authors.lastname: Shiraishi
authors.forename: Seigo
authors.initials: S
authors.lastname: Kitano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016063:Blood Loss, Surgical; D059248:Chemoradiotherapy; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008207:Lymphatic Metastasis; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control*; D009367:Neoplasm Staging; D061646:Operative Time; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: chemoradiation therapy; laparoscopic surgery; rectal cancer