Abstract
BackgroundConversion and anastomotic leakage in colorectal cancer surgery have been suggested to have a negative impact on long-term oncologic outcomes. The aim of this study in a large Dutch national cohort was to analyze the influence of conversion and anastomotic leakage on long-term oncologic outcome in rectal cancer surgery. MethodsPatients were selected from a retrospective cross-sectional snapshot study. Patients with a benign lesion, distant metastasis, or unknown tumor or metastasis status were excluded. Overall (OS) and disease-free survival (DFS) were compared between laparoscopic, converted, and open surgery as well as between patients with and without anastomotic leakage. ResultsOut of a database of 2095 patients, 638 patients were eligible for inclusion in the laparoscopic, 752 in the open, and 107 in the conversion group. A total of 746 patients met the inclusion criteria and underwent low anterior resection with primary anastomosis, including 106 (14.2%) with anastomotic leakage. OS and DFS were significantly shorter in the conversion compared to the laparoscopic group (p = 0.025 and p = 0.001, respectively) as well as in anastomotic leakage compared to patients without anastomotic leakage (p = 0.002 and p = 0.024, respectively). In multivariable analysis, anastomotic leakage was an independent predictor of OS (hazard ratio 2.167, 95% confidence interval 1.322–3.551) and DFS (1.592, 1077–2.353). Conversion was an independent predictor of DFS (1.525, 1.071–2.172), but not of OS. ConclusionTechnical difficulties during laparoscopic rectal cancer surgery, as reflected by conversion, as well as anastomotic leakage have a negative prognostic impact, underlining the need to improve both aspects in rectal cancer surgery.
Highlights
IntroductionAmsterdam, the Netherlands recovery time, and less blood loss.[1,2,3] Its oncologic safety and equivalence to open surgery has been demonstrated in a number of randomized clinical trials.[4,5,6,7,8,9] Total mesorectal excision (TME) surgery, both open and laparoscopic, is still associated with considerable morbidity
Total mesorectal excision (TME), being the cornerstone of rectal cancer treatment, has gradually evolved in the past decade from open surgery to a laparoscopic approach, as it has shown advantageous short-term outcomes and a lower postoperative complication rate, including less pain, improvedAmsterdam, Amsterdam, the Netherlands recovery time, and less blood loss.[1,2,3] Its oncologic safety and equivalence to open surgery has been demonstrated in a number of randomized clinical trials.[4,5,6,7,8,9] TME surgery, both open and laparoscopic, is still associated with considerable morbidity
Subgroup analysis in the CLASSIC trial has suggested an inferior overall survival in converted patients compared to patients in whom laparoscopic resection was completed successfully, and even worse outcomes compared to primary open resection as well.[6]
Summary
Amsterdam, the Netherlands recovery time, and less blood loss.[1,2,3] Its oncologic safety and equivalence to open surgery has been demonstrated in a number of randomized clinical trials.[4,5,6,7,8,9] TME surgery, both open and laparoscopic, is still associated with considerable morbidity Both intra-operative and postoperative complications have been associated with shorter overall survival and unfavorable oncologic outcomes,[10,11] some studies failed to show a direct relationship.[12,13] Due to the complex nature of the procedure, conversion from laparoscopic to open surgery is still reported in up to 30% of cases.[14]. The aim of this study in a large Dutch national cohort was to analyze the influence of conversion and anastomotic leakage on long-term oncologic outcome in rectal cancer surgery
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