title: Long-term outcomes and propensity score matching analysis: rectal cancer resection for patients with elevated preoperative risk.
abstract: BACKGROUND
  It is still controversial about the treatment strategy for rectal cancer patients with elevated operative risk and elder rectal cancer patients.
  
  
  METHODS
  This study presented a retrospective single center experience in rectal cancer proctectomy for high operative risk patients. High operative risk patient was defined as Cr-POSSUM > 5% combined with associated risk factors. 220 in 1477 consecutive patients met the inclusion criteria.
  
  
  RESULTS
  132 patients were selected (66:66) after propensity score matching. The total complication rate between conventional open rectal resection (71 %) and laparoscopic surgery (41%) was significantly different (p = 0.0005). There is a significantly positive correlation between open surgery and advanced Dindo Classification (p = 0.02). Cr-POSSUM is positively correlated with Dindo Classification (p = 0.01). There was no significant difference in survival rate among stage I~II, different age groups or different Cr-POSSUM score sub-groups. However, stage III-IV tumor patients in laparoscopic group experienced improved overall survival rate. (p < 0.0001). For patients with preoperative pulmonary or renal disease, patients in laparoscopic group also had better long term prognosis (p = 0.03, p = 0.049).
  
  
  CONCLUSIONS
  The results demonstrate the potential advantages of laparoscopic rectal cancer resection for high operative risk patients, especially for the patients with preoperative respiratory or renal disease and stage III cancer.
authors.affiliation: Department of Digestive Surgery, Ruijin Hospital, Shanghai Jiao-tong University School of Medicine, Shanghai, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Feng
authors.affiliation: Department of General, Visceral, Transplant, and Vascular Surgery, University Hospital of Ludwig Maximilian University of Munich, Munich, Germany.
authors.forename: Tobias S
authors.initials: TS
authors.lastname: Schiergens
authors.affiliation: Department of Digestive Surgery, Ruijin Hospital, Shanghai Jiao-tong University School of Medicine, Shanghai, China.
authors.forename: Zhi-Hai
authors.initials: ZH
authors.lastname: Mao
authors.affiliation: Department of Digestive Surgery, Ruijin Hospital, Shanghai Jiao-tong University School of Medicine, Shanghai, China.
authors.forename: Jingkun
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Digestive Surgery, Ruijin Hospital, Shanghai Jiao-tong University School of Medicine, Shanghai, China.
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Shen
authors.affiliation: Department of Digestive Surgery, Ruijin Hospital, Shanghai Jiao-tong University School of Medicine, Shanghai, China.
authors.forename: Ai-Guo
authors.initials: AG
authors.lastname: Lu
authors.affiliation: Department of General and Visceral Surgery, Red Cross Hospital of Munich, Munich, Germany.
authors.forename: Wolfgang E
authors.initials: WE
authors.lastname: Thasler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D063868:Patient Outcome Assessment; D011183:Postoperative Complications; D057234:Preoperative Period; D011379:Prognosis; D057216:Propensity Score; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment
keywords: Cr-POSSUM system; complications; laparoscopy; operative risk; rectal cancer