Multicentre propensity score-matched analysis of laparoscopic versus open surgery for T4 rectal cancer.
The use of laparoscopy for advanced-stage rectal cancer remains controversial. This study aimed to compare the operative and oncologic outcomes of laparoscopic (LAR) versus open anterior rectal resection (OAR) for patients with pT4 rectal cancer.



This is a multicenter propensity score matching (PSM) study of patients undergoing elective curative-intent LAR or OAR for pT4 rectal cancer (TNM stage II/III/IV) between 2005 and 2015.



In total, 137 patients were included in the analysis. After PSM, demographic, clinical and tumor characteristics were similar between the 52 LAR and the 52 OAR patients. Overall, 52 tumors were located in the high rectum, 25 in the mid-rectum and 27 in the low rectum. Multivisceral resection was performed in 26.9% of LAR and 30.8% of OAR patients (p = 0.829). Conversion was required in 11 LAR patients (21.2%). The LAR group showed significantly shorter time to flatus (3.13 vs. 4.97 days, p = 0.001), time to regular diet (3.59 vs. 6.36 days, p < 0.0001) and hospital stay (15.49 vs. 17.96 days, p = 0.002) compared to the OAR group. The 90-day morbidity and mortality were not different between groups. In the majority of patients (85.6%), R0 resection was achieved. A complete mesorectal excision was obtained in 82.7% of LAR and 78.8% of OAR patients (p = 0.855). The 1-, 2- and 3-year overall survival rates were, respectively, 95.6, 73.8 and 66.7% for the LAR group and 86.7, 66.9 and 64.1% for the OAR group (p = 0.219). The presence of synchronous metastases (hazard ratio 2.26), R1 resection (HR 2.71) and lymph node involvement (HR 2.24) were significant predictors of overall survival.



The present study suggests that LAR for pT4 rectal cancer can achieve good pathologic and oncologic outcomes similar to open surgery despite the risk of conversion. Moreover, laparoscopy offers the benefits of a faster recovery and a shorter hospital stay.
Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France. nic.deangelis@yahoo.it.
Nicola
0000-0002-1211-4916
N
de'Angelis
Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.|Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain.|Universidad Autonoma de Barcelona, UAB, Barcelona, Spain.
Filippo
F
Landi
Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland.
Giulio Cesare
GC
Vitali
Department of Digestive Surgery, University Hospital of Strasbourg, 67091, Strasbourg, France.
Riccardo
R
Memeo
Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
Aleix
A
Martínez-Pérez
Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain.|Universidad Autonoma de Barcelona, UAB, Barcelona, Spain.
Alejandro
A
Solis
Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland.
Michela
M
Assalino
Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain.|Universidad Autonoma de Barcelona, UAB, Barcelona, Spain.
Francesc
F
Vallribera
Department of Digestive Surgery, University Hospital of Strasbourg, 67091, Strasbourg, France.
Henry Alexis
HA
Mercoli
Department of Digestive Surgery, University Hospital of Strasbourg, 67091, Strasbourg, France.
Jacques
J
Marescaux
Department of Digestive Surgery, University Hospital of Strasbourg, 67091, Strasbourg, France.
Didier
D
Mutter
Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland.
Frédéric
F
Ris
Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain.|Universidad Autonoma de Barcelona, UAB, Barcelona, Spain.
Eloy
E
Espin
Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
Francesco
F
Brunetti
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D057216:Propensity Score; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome
Laparoscopy; Locally advanced rectal cancer; Open surgery; Propensity score matching; Radiochemotherapy; Rectal cancer