Laparoscopic-assisted abdominoperineal resection for low rectal cancer provides a shorter length of hospital stay while not affecting the recurrence or survival: a propensity score-matched analysis.
OBJECTIVE
To compare the short- and intermediate-term outcomes of open versus laparoscopic abdominoperineal resection (APR) for low rectal cancer.


METHODS
Elective open and laparoscopic APRs were identified in a prospective database and were 1:1 propensity score-matched for age, ASA grade, tumour stage and type of neoadjuvant therapy. The short- and intermediate-term outcomes were compared.


RESULTS
From January 2003 until June 2013, a total of 135 APRs (87 open, 48 laparoscopic) were identified and matched (n = 96, standardised mean difference of covariates <0.25). The thirty-day mortality, R0 rate, lymph nodes harvested and reoperations were similar. The length of the hospital stay was shorter in the laparoscopic group [10 versus 14 days, p = 0.004 (Mann-Whitney U test), Bonferroni-corrected significance level = 0.0083]. The median follow-up was 4.6 (IQR: 2.0-6.0) years. The overall and recurrence-free 3-year survival rate estimates (Kaplan-Meier method; 95 % CI in brackets) were 71 % (59-86) and 57 % (44-73) in the open group versus 78 % (66-92) and 72 % (60-87) in the laparoscopic group, respectively [p = 0.167 and p = 0.186 (log-rank test), respectively]. The 3-year cumulative incidence of recurrence was 27 % (15-40) in the open group and 16 % (8-29) in the laparoscopic group [p = 0.359 (Gray's test)].


CONCLUSIONS
Compared to open APR, laparoscopic APR provided a shorter length of hospital stay while showing no intermediate-term differences in the survival or cumulative incidence of recurrence.
Minimally Invasive Colorectal Unit, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK. manfred.odermatt@gmx.ch.
Manfred
M
Odermatt
Minimally Invasive Colorectal Unit, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK.
Karen
K
Flashman
Minimally Invasive Colorectal Unit, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK.
Jim
J
Khan
Minimally Invasive Colorectal Unit, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK.
Amjad
A
Parvaiz
D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010502:Perineum / Q000601:surgery; D057216:Propensity Score; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate
Abdominoperineal resection; Advanced rectal cancer; Laparoscopic total mesorectal excision; Recurrence