Effects of three-dimensional and two-dimensional laparoscopic surgeries for rectal cancer after neoadjuvant chemoradiation therapy

Abstract

Objective To compare the clinical effects of three-dimensional (3D) and two-dimensional (2D) laparoscopic surgeries for rectal cancer (RC) after neoadjuvant chemoradiation therapy (nCRT). Methods The retrospective cohort study was conducted. The clinicopathological data of 126 patients with RC who received laparoscopic surgery after nCRT in the Liaoning Cancer Hospital from January 2013 to January 2014 were collected. Of 126 patients, 63 undergoing 3D laparoscopic surgery and 63 undergoing 2D laparoscopic surgery were respectively allocated into the 3D and 2D groups. Surgery was performed by the same doctors′ team. Patients received surgery at 6-8 weeks after nCRT, and surgery followed the principle of total mesorectal excision. Observation indicators: (1) intra- and post-operative situations; (2) postoperative pathological examination; (3) follow-up and survival situations. Follow-up using outpatient examination and telephone interview was performed to detect local tumor recurrence and patients′ survival up to January 2017. Patients received reexaminations once every 3 months within 1 year postoperatively and once every 6 months after 2-3 years postoperatively. Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed using the t test. Comparisons of count data were analyzed using the chi-square test. Comparison of ordinal data was done by the nonparametric test. Survival curve was drawn using the Kaplan-Meier method. Survival was analyzed using the Log-rank test. Results (1) Intra- and post-operative situations: all the patients underwent successful laparoscopic surgery for RC, without conversion to open surgery and perioperative death. Operation time, volume of intraoperative blood loss, time to anal exsufflation and number of patients with postoperative urinary dysfunction were (125±10)minutes, (54±23)mL, (44±5)hours, 0 in the 3D group and (137±12)minutes, (62±20)mL, (46±5)hours, 5 in the 2D group, respectively, with statistically significant differences between the 2 groups (t=5.777, 2.038, 2.575, χ2=7.138, P 0.05). Two and 4 patients with anastomotic leakage in the 3D and 2D groups received defunctioning stoma, and finally anastomotic leakage healed, without anastomotic stenosis. Of 5 patients with urinary dysfunction in the 2D group, 4 received indwelling catheter for 3 weeks and then can micturate autonomously after indwelling catheter removal, 1 received indwelling catheter for 3 months and then can micturate autonomously after indwelling catheter removal, without suprapubic cystostomy. (2) Postoperative pathological examination: 0 and 4 patients in the 3D and 2D groups had positive circumferential margin, with a statistically significant difference (χ2=5.676, P 0.05). Number of patients with stage Ⅱ and Ⅲ of postoperative pathological staging were 30, 33 in the 3D group and 32, 31 in the 2D group, respectively, with no statistically significant difference between the 2 groups (χ2=0.127, P>0.05). (3) Follow-up and survival situations: 126 patients were followed up for 36.0-48.0 months, with a median time of 39.5 months. During the follow-up, 0 and 3 patients in the 3D and 2D groups were complicated with local tumor recurrence, with a statistically significant difference between the 2 groups (χ2=4.232, P 0.05). One- and 3-year disease-free survival rates were 92.7%, 77.8% in the 3D group and 90.5%, 73.0% in the 2D group, respectively, with no statistically significant difference between the 2 groups (χ2=0.421, P>0.05). Conclusion Compared with 2D laparoscopic surgery, 3D laparoscopic surgery for RC after nCRT is safe and feasible, it can also shorten operation time, reduce intraoperative bleeding, alleviate the influence of intestinal peristalsis function, protect pelvic nerves better and improve operation quality. Key words: Rectal neoplasms; Neoadjuvant chemoradiation therapy; Radical resection; Laparoscopy; Three-dimensional technology