title: Long-term oncologic outcomes of laparoscopic vs open surgery for stages II and III rectal cancer: A retrospective cohort study.
abstract: OBJECTIVE
  To evaluate the 5-year survival after laparoscopic surgery vs open surgery for stages II and III rectal cancer.
  
  
  METHODS
  This study enrolled 406 consecutive patients who underwent curative resection for stages II and III rectal cancer between January 2000 and December 2009 [laparoscopic rectal resection (LRR), n = 152; open rectal resection (ORR), n = 254]. Clinical characteristics, operative outcomes, pathological outcomes, postoperative recovery, and 5-year survival outcomes were compared between the two groups.
  
  
  RESULTS
  Most of the clinical characteristics were similar except age (59 years vs 55 years, P = 0.033) between the LRR group and ORR group. The proportion of anterior resection was higher in the LRR group than that in the ORR group (81.6% vs 66.1%, P = 0.001). The LRR group had less estimated blood loss (50 mL vs 200 mL, P < 0.001) and a lower rate of blood transfusion (4.6% vs 11.8%, P = 0.019) compared to the ORR group. The pathological outcomes of the two groups were comparable. The LRR group was associated with faster recovery of bowel function (2.8 d vs 3.7 d, P < 0.001) and shorter postoperative hospital stay (11.7 d vs 13.7 d, P < 0.001). The median follow-up time was 63 mo in the LRR group and 65 mo in the ORR group. As for the survival outcomes, the 5-year local recurrence rate (16.0% vs 16.4%, P = 0.753), 5-year disease-free survival (DFS) rate (63.0% vs 63.1%, P = 0.589), and 5-year overall survival (OS) rate (68.1% vs 63.5%, P = 0.682) were comparable between the LRR group and the ORR group. Stage by stage, there were also no statistical differences between the LRR group and the ORR group in terms of the 5-year local recurrence rate (stage II: 6.3% vs 8.7%, P = 0.623; stage III: 26.4% vs 23.2%, P = 0.747), 5-year DFS rate (stage II: 77.5% vs 77.6%, P = 0.462; stage III: 46.5% vs 50.9%, P = 0.738), and 5-year OS rate (stage II: 81.4% vs 74.3%, P = 0.242; stage III: 53.9% vs 54.1%, P = 0.459).
  
  
  CONCLUSIONS
  LRR for stages II and III rectal cancer can yield comparable long-term survival while achieving short-term benefits compared to open surgery.
authors.affiliation: Zhen-Xu Zhou, Li-Ying Zhao, Tian Lin, Hao Liu, Hai-Jun Deng, Heng-Liang Zhu, Jun Yan, Guo-Xin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
authors.forename: Zhen-Xu
authors.initials: ZX
authors.lastname: Zhou
authors.affiliation: Zhen-Xu Zhou, Li-Ying Zhao, Tian Lin, Hao Liu, Hai-Jun Deng, Heng-Liang Zhu, Jun Yan, Guo-Xin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
authors.forename: Li-Ying
authors.initials: LY
authors.lastname: Zhao
authors.affiliation: Zhen-Xu Zhou, Li-Ying Zhao, Tian Lin, Hao Liu, Hai-Jun Deng, Heng-Liang Zhu, Jun Yan, Guo-Xin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
authors.forename: Tian
authors.initials: T
authors.lastname: Lin
authors.affiliation: Zhen-Xu Zhou, Li-Ying Zhao, Tian Lin, Hao Liu, Hai-Jun Deng, Heng-Liang Zhu, Jun Yan, Guo-Xin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
authors.affiliation: Zhen-Xu Zhou, Li-Ying Zhao, Tian Lin, Hao Liu, Hai-Jun Deng, Heng-Liang Zhu, Jun Yan, Guo-Xin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
authors.forename: Hai-Jun
authors.initials: HJ
authors.lastname: Deng
authors.affiliation: Zhen-Xu Zhou, Li-Ying Zhao, Tian Lin, Hao Liu, Hai-Jun Deng, Heng-Liang Zhu, Jun Yan, Guo-Xin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
authors.forename: Heng-Liang
authors.initials: HL
authors.lastname: Zhu
authors.affiliation: Zhen-Xu Zhou, Li-Ying Zhao, Tian Lin, Hao Liu, Hai-Jun Deng, Heng-Liang Zhu, Jun Yan, Guo-Xin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Yan
authors.affiliation: Zhen-Xu Zhou, Li-Ying Zhao, Tian Lin, Hao Liu, Hai-Jun Deng, Heng-Liang Zhu, Jun Yan, Guo-Xin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
authors.forename: Guo-Xin
authors.initials: GX
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D019106:Postoperative Hemorrhage / Q000628:therapy; D016016:Proportional Hazards Models; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Laparoscopic surgery; Locally advanced rectal cancer; Oncologic outcomes