title: Impact of type of surgery (laparoscopic versus open) on the time to initiation of adjuvant chemotherapy in operable rectal cancers.
abstract: OBJECTIVE
  The COREAN (comparison of open vs. laparoscopic surgery for mid- and low-rectal cancer after neoadjuvant chemoradiotherapy) and the MRC-CLASICC (Medical Research Council-conventional vs. laparoscopic-assisted surgery in colorectal cancer) trials have established the benefits of laparoscopic surgery in rectal cancers regarding shortened hospital stay and speedy recovery. A rapid postoperative recovery is essential for initiation of adjuvant therapy, especially in stage II/III rectal cancers. This study aimed to evaluate whether the type of surgery (laparoscopic or open) had any bearing on the time to initiation of adjuvant chemotherapy (TIAC) after complete radical surgical proctectomy.
  
  
  METHODS
  A subset of 181 consecutive patients of operable rectal cancer, who underwent curative resection of the rectum (laparoscopic or open) and received postoperative adjuvant chemotherapy between July 2013 and December 2014 at a single institution, was studied. The TIAC and the factors determining the same, namely, type of surgery, age, gender, presence of complications, and body mass index, were analyzed.
  
  
  RESULTS
  Of 181 patients, 57 underwent laparoscopic and 124 open resection. Overall complications were seen in 17.6 % (32) patients, 8 in the laparoscopic arm and 24 in the open arm. The median time to start adjuvant chemotherapy after surgery was 21.6 and 23.73 days (p = 0.94) in the laparoscopic and open groups, respectively. On multivariate analysis, the type of surgery (p = 0.398) did not influence the TIAC. The only factor that influenced the TIAC was postoperative complications (p = 0.001).
  
  
  CONCLUSIONS
  Our study shows that laparoscopic surgery for rectal cancer did not lead to an earlier start of adjuvant chemotherapy.
authors.affiliation: Department of Surgical Oncology, Tata Memorial Hospital, Dr. Ernest Borges Road, Parel, Mumbai, 400 012, India.
authors.forename: Snita
authors.initials: S
authors.lastname: Sinukumar
authors.affiliation: Department of Gastroenterology, Tata Memorial Hospital, Dr. Ernest Borges Road, Parel, Mumbai, 400 012, India.
authors.forename: Shaesta
authors.initials: S
authors.lastname: Mehta
authors.affiliation: Department of Medical Oncology, Tata Memorial Hospital, Dr. Ernest Borges Road, Parel, Mumbai, 400 012, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Ostwal
authors.affiliation: Department of Surgical Oncology, Tata Memorial Hospital, Dr. Ernest Borges Road, Parel, Mumbai, 400 012, India.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Jatal
authors.affiliation: Department of Surgical Oncology, Tata Memorial Hospital, Dr. Ernest Borges Road, Parel, Mumbai, 400 012, India. asaklani@hotmail.com.
authors.forename: Avanish
authors.initials: A
authors.lastname: Saklani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: Adjuvant chemotherapy; Laparoscopic surgery; Rectal cancer