Long-term oncologic outcomes of laparoscopic vs open surgery for stages Ⅱ and Ⅲ rectal cancer: A retrospective cohort study

AIM: To evaluate the 5-year survival after laparoscopic surgery vs open surgery for stages Ⅱ and Ⅲ rectal cancer.METHODS:This study enrolled 406 consecutive patients who underwent curative resection for stagesⅡandⅢrectal cancer between January 2000 and December 2009[laparoscopic rectal resection(LRR),n=152;open rectal resection(ORR),n=254].Clinical characteristics,operative outcomes,pathological outcomes,postoperative recovery,and 5-year survival outcomes were compared between the two groups.RESULTS:Most of the clinical characteristics were similar except age(59 years vs 55 years,P=0.033)between the LRR group and ORR group.The proportion of anterior resection was higher in the LRR group than that in the ORR group(81.6%vs 66.1%,P=0.001).The LRR group had less estimated blood loss(50m L vs 200 m L,P<0.001)and a lower rate of blood transfusion(4.6%vs 11.8%,P=0.019)compared to the ORR group.The pathological outcomes of the two groups were comparable.The LRR group was associated with faster recovery of bowel function(2.8 d vs 3.7 d,P<0.001)and shorter postoperative hospital stay(11.7 d vs 13.7 d,P<0.001).The median followup time was 63 mo in the LRR group and 65 mo in the ORR group.As for the survival outcomes,the 5-year local recurrence rate(16.0%vs 16.4%,P=0.753),5-year disease-free survival(DFS)rate(63.0%vs63.1%,P=0.589),and 5-year overall survival(OS)rate(68.1%vs 63.5%,P=0.682)were comparable between the LRR group and the ORR group.Stageby stage,there were also no statistical differences between the LRR group and the ORR group in terms of the 5-year local recurrence rate(stageⅡ:6.3%vs 8.7%,P=0.623;stageⅢ:26.4%vs 23.2%,P=0.747),5-year DFS rate(stageⅡ:77.5%vs 77.6%,P=0.462;stageⅢ:46.5%vs 50.9%,P=0.738),and5-year OS rate(stageⅡ:81.4%vs 74.3%,P=0.242;stageⅢ:53.9%vs 54.1%,P=0.459).CONCLUSION:LRR for stagesⅡandⅢrectal cancer can yield comparable long-term survival while achieving short-term benefits compared to open surgery.