Abstract
BackgroundLaparoscopic resections for rectal cancer are routinely performed in high-volume centres. Despite short-term advantages have been demonstrated, the oncological outcomes are still debated. The aim of this study was to compare the oncological adequateness of the surgical specimen and the long-term outcomes between open (ORR) and laparoscopic (LRR) rectal resections.MethodsPatients undergoing laparoscopic or open rectal resections from January 1, 2013, to December 31, 2019, were enrolled. A 1:2 propensity score matching was performed according to age, sex, BMI, ASA score, comorbidities, distance from the anal verge, and clinical T and N stage.ResultsNinety-eight ORR were matched to 50 LRR. No differences were observed in terms of operative time (224.9 min. vs. 230.7; p = 0.567) and postoperative morbidity (18.6% vs. 20.8%; p = 0.744). LRR group had a significantly earlier soft oral intake (p < 0.001), first bowel movement (p < 0.001), and shorter hospital stay (p < 0.001). Oncological adequateness was achieved in 85 (86.7%) open and 44 (88.0%) laparoscopic resections (p = 0.772). Clearance of the distal (99.0% vs. 100%; p = 0.474) and radial margins (91.8 vs. 90.0%, p = 0.709), and mesorectal integrity (94.9% vs. 98.0%, p = 0.365) were comparable between groups. No differences in local recurrence (6.1% vs.4.0%, p = 0.589), 3-year overall survival (82.9% vs. 91.4%, p = 0.276), and disease-free survival (73.1% vs. 74.3%, p = 0.817) were observed.ConclusionsLRR is associated with good postoperative results, safe oncological adequateness of the surgical specimen, and comparable survivals to open surgery.
Highlights
Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth cause of cancer-related deaths
Three patients who underwent transanal endoscopic microsurgery (TEM), 6 transanal minimally invasive surgery (TAMIS), 54 endoscopic resections, 15 resections of surrounding structures, 5 metachronous colonic resections, 3 major liver resections, 10 multiple hepatic wedge resections, 3 metastasectomies larger than 4 cm, and 2 concomitant resections of other abdominal malignancies were excluded from the study
Most of the tumours were located lower than 10 cm from the anal verge with no differences between ORR and laparoscopic resection for rectal cancer (LRR) groups (62.7% vs. 60.9%; p = 0.641)
Summary
Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth cause of cancer-related deaths. Int J Colorectal Dis (2021) 36:801–810 robotics have been implemented in the last 30 years In this setting, laparoscopic resection for right and left colon cancer has been associated with better short-term outcomes and similar survivals as compared to open [6,7,8,9,10,11,12]. Notwithstanding, laparoscopic resection for rectal cancer (LRR) has not been validated yet by international guidelines, unless it is being performed in high-volume centres by experienced surgeons [1, 3]. The aim of this study was to compare the oncological adequateness of the surgical specimen and the long-term outcomes between open (ORR) and laparoscopic (LRR) rectal resections
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