Comparison of safety and long-term outcomes of laparoscopic versus open radical resection for rectal cancer

Abstract

Objective To compare the safety and the long-term outcomes of laparoscopic and open radical resection for rectal cancer. Methods The clinical data of 602 patients who received radical resection at the Second Affiliated Hospital of Fujian Medical University from January 2000 to December 2008 were retrospectively analyzed.All patients were divided into the laparoscope group (324 patients) and the open group (278 patients).The numbers of dissected lymph nodes,lengths of proximal and distal resection margins,local recurrence rate,distal metastasis rate,overall survival rates and disease-free survival rates of the 2 groups were compared.All data were analyzed by the independent t test,chi-square test or Fisher exact probability. The survival rates were calculated by the life table method and were analyzed by the Wilcoxon (Gehan) test.Results The number of lymph nodes dissected in the laparoscope group and the open group were 21 ± 8 and 21 ± 9,with no significant difference between the 2 groups (t =1.120,P ＞0.05).The lengths of proximal resection margin were ( 15.1 ±1.3 )cm in the laparoscope group and (15.0 ±0.8)cm in the open group,with no significant difference between the2groups (t =1.452,P ＞0.05).The lengths of distal resection margin were (4.0 ± 1.6)cm in the laparoscope group and (3.3 ± 1.4) cm in the open group,with a significant difference between the 2 groups ( t =5.587,P ＜ 0.05 ).The overall local recurrence rate was 5.6％ (34/602),and no tumor recurrence was detected in the incision and port-site.The local reccurence rates were 6.2％ (20/324) in the laparoscope group and 5.0％(14/278) in the open group,with no significant difference between the 2 groups (x2 =0.363,P ＞ 0.05 ).The overall distal metastasis rate was 11.5％ (69/602),and the distal metastasis rates were 11.1％ (36/324) in the laparoscope group and 11.9％ (33/278) in the open group,with no significant difference between the 2 groups (x2 =0.085,P ＞0.05).The 3- and 5-year survival rates were 87.8％ and 83.0％ in the laparoscope group,and 84.9％ and 79.3％ in the open group,with no significant difference between the 2 groups (P ＞0.05).The 3- and 5-year tumor-free survival rates were 79.4％ and 69.2％ in the laparoscope group,and 79.7％ and 73.1％ in the open group,with no significant difference between the 2 groups ( P ＞ 0.05 ).The follow-up rate was 81.2％ (489/602).Forty-nine patients died,including 20 patients in the laparoscope group and 29 patients in the open group.Conclusion Laparoscopic radical resection for rectal cancer is reliable in the oncological efficacy,and is possible to achieve the similar long-term outcomes as that of open surgery. Key words: Rectal neoplasms; Laparoscopy; Survival analysis