title: Ten-year outcomes following laparoscopic colorectal resection: results of a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate the impact of laparoscopy compared to open surgery on long-term outcomes in a large series of patients who participated in a randomized controlled trial comparing short-term results of laparoscopic (LPS) versus open colorectal resection.
  
  
  METHODS
  This is a retrospective review of a prospective database including 662 patients with colorectal disease (526, 79 % cancer patients) who were randomly assigned to LPS or open colorectal resection and followed every 6 months by office visits. The primary endpoint of the study was long-term morbidity. Secondary outcomes included 10-year overall, cancer-specific, and disease-free survivals. All patients were analyzed on an intention-to-treat basis.
  
  
  RESULTS
  Fifty-eight (8.8 %) patients were lost to follow-up. Median follow-up was 131 (IQR 78-153) months in the LPS group and 126 (IQR 52-152) months in the open group (p = 0.121). Overall, long-term morbidity rate was 11.8 % (36/309) in the LPS versus 12.6 % (37/295) in the open group (p = 0.770). Incisional hernia rate was 5.8 % (18/309) in the LPS group versus 8.1 % (24/295) in the open group (p = 0.264). Adhesion-related small-bowel obstruction occurred in five (1.6 %) patients in the LPS versus four (1.4 %) patients in the open group (p = 1.000). In 497 cancer patients, 10-year overall survival was 45.3 % in the LPS group and 40.9 % in the open group (p = 0.160). No difference was found in cancer-specific and disease-free survivals, also when patients were stratified according to cancer stage.
  
  
  CONCLUSIONS
  In this series, LPS colorectal resection was not associated with a lower long-term morbidity rate when compared to open surgery. Overall, cancer-specific and disease-free survivals were similar in cancer patients who were treated with LPS and open surgeries.
authors.affiliation: Department of Surgery, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Pecorelli
authors.affiliation: Department of Surgery, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Amodeo
authors.affiliation: Department of Surgery, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Frasson
authors.affiliation: Department of Surgery, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vignali
authors.affiliation: Department of Surgery, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Walter
authors.initials: W
authors.lastname: Zuliani
authors.affiliation: Department of Surgery, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy. braga.marco@hsr.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Braga
mesh_terms: D000368:Aged; D003107:Colorectal Surgery / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation; D016896:Treatment Outcome
keywords: Colon cancer; Laparoscopy; Postoperative complications; Survival analysis; Ventral hernia