Abstract
BACKGROUNDIt is still controversial about the treatment strategy for rectal cancer patients with elevated operative risk and elder rectal cancer patients.METHODSThis 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.RESULTS132 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).CONCLUSIONSThe 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.
Highlights
Rectal cancer is associated with substantial morbidity and mortality, especially in elder patients and those with co-morbidities
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
Can these recommendations from major studies, such as laparoscopic rectal operations are safe and sound, be extrapolated to the fragile subset of patients with more comorbidity or do they need to be modified? The aim of this study is to analysis the survival and outcomes in patients with rectal cancer associated with high operative risk in conventional open rectal resection group (OpS) and laparoscopic rectal resection group (LaPS)
Summary
Rectal cancer is associated with substantial morbidity and mortality, especially in elder patients and those with co-morbidities. Though some of the randomized control trials have included patients with elevated preoperative risk (American Society of Anesthesiologists classification 3 and 4), these patients were generally recruited to clinical trials less often than younger patients and www.impactjournals.com/oncotarget are under-represented in publications about cancer treatment [7]. Because of this heterogeneous, can these recommendations from major studies, such as laparoscopic rectal operations are safe and sound, be extrapolated to the fragile subset of patients with more comorbidity or do they need to be modified? It is still controversial about the treatment strategy for rectal cancer patients with elevated operative risk and elder rectal cancer patients
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