Survival outcomes following laparoscopic vs open surgery for non-metastatic rectal cancer: a two-center cohort study with propensity score matching

Abstract Background:?> Laparoscopic surgery for rectal cancer is commonly performed in China. However, compared with open surgery, the effectiveness of laparoscopic surgery, especially the long-term survival, has not been sufficiently proved. Methods:?> Data of eligible patients with non-metastatic rectal cancer at Nanfang Hospital of Southern Medical University and Guangdong Provincial Hospital of Chinese Medicine between 2012 and 2014 were retrospectively reviewed. Long-term survival outcomes and short-term surgical safety were analysed with propensity score matching between groups. Results Of 430 cases collated from two institutes, 103 matched pairs were analysed after propensity score matching. The estimated blood loss during laparoscopic surgery was significantly less than that during open surgery (P = 0.019) and the operative time and hospital stay were shorter in the laparoscopic group (both P < 0.001). The post-operative complications rate was 9.7% in the laparoscopic group and 10.7% in the open group (P = 0.818). No significant difference was observed between the laparoscopic group and the open group in the 5-year overall survival rate (75.7% vs 80.6%, P = 0.346), 5-year relapse-free survival rate (74.8% vs 76.7%, P = 0.527), or 5-year cancer-specific survival rate (79.6% vs 87.4%, P = 0.219). An elevated carcinoembryonic antigen, <12 harvested lymph nodes, and perineural invasion were independent prognostic factors affecting overall survival and relapse-free survival. Conclusions:?> Our findings suggest that open surgery should still be the priority recommendation, but laparoscopic surgery is also an acceptable treatment for non-metastatic rectal cancer.

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Comparison of long-term survival outcomes between laparoscopic and open surgery for mid or low rectal cancer treated with preoperative chemoradiotherapy: 7-year follow-up of COREAN trial.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.3518 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 3518-3518

Author(s):

Ji Won Park ◽

Seung-Yong Jeong ◽

Sung-Bum Kang ◽

Jungnam Joo ◽

Mi Kyung Song ◽

...

Keyword(s):

Rectal Cancer ◽

Laparoscopic Surgery ◽

Local Recurrence ◽

Open Surgery ◽

Disease Free Survival ◽

Preoperative Chemoradiotherapy ◽

Low Rectal Cancer ◽

Free Survival ◽

Disease Free

3518 Background: Laparoscopic surgery for rectal cancer has been used widely. However, recent two randomized trials raised concerns about short-term oncologic safety of laparoscopic surgery for rectal cancer. The aim of this study was to evaluate the long-term oncologic safety of laparoscopic surgery for rectal cancer based on 7-year data from the Comparison of Open versus laparoscopic surgery for mid or low REctal cancer After Neoadjuvant chemoradiotherapy (COREAN) trial. Methods: COREAN trial was a non-inferiority, randomized controlled trial. Between April, 2006, and Aug, 2009, eligible participants with mid or low rectal cancer treated with preoperative chemoradiotherapy were randomly assigned (1:1) to laparoscopic (n = 170) or open surgery (n = 170). Seven-year outcomes included overall and disease-free survival, and local recurrence. Log-rank test and stratified Cox regression analysis were used for survival analysis. Analysis was by intention to treat. Results: The median follow-up times were 84 months (IQR: 61.5-97.0). No differences were found between laparoscopic and open surgery group in terms of overall and disease-free survival, and local recurrence (7-year overall survival: 83.2% [laparoscopic] vs 77.3% [open], p = 0.48; 7-year disease-free survival: 71.6% [laparoscopic] vs 64.3% [open], p = 0.20; 7-year local recurrence: 3.3% [laparoscopic] vs 7.9% [open], p = 0.08). Stratified Cox regression analysis adjusted for ypT, ypN and tumor regression grade showed no significant difference between groups in terms of overall and disease-free survival, and local recurrence. The hazard ratios for overall survival, disease-free survival and local recurrence (open vs laparoscopic surgery) were 0.96 (95% CI = 0.58-1.57), 1.03 (95% CI = 0.70-1.53), and 2.28 (95% CI = 0.82-7.16), respectively. Conclusions: The 7-year analysis confirm the long-term oncological safety of laparoscopic surgery for rectal cancer treated with preoperative chemoradiotherapy. The use of laparoscopic surgery does not compromise the long-term survival outcomes in rectal cancer. Clinical trial information: NCT00470951.

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Laparoscopic versus open surgery for gastrointestinal stromal tumor in esophagogastric junction: A multi-center, retrospective cohort analysis with propensity score matching.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.11534 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 11534-11534

Author(s):

Wenjun Xiong ◽

Tao Chen ◽

Xingyu Feng ◽

Yuting Xu ◽

Jin Wan ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Propensity Score ◽

Blood Loss ◽

Gastrointestinal Stromal Tumor ◽

Propensity Score Matching ◽

Open Surgery ◽

Esophagogastric Junction ◽

Operative Time ◽

Liquid Intake

11534 Background: Laparoscopic resection is increasingly performed for Gastrointestinal stromal tumor (GIST). Nevertheless, laparoscopic approach for the GIST located in the esophagogastric junction (EGJ-GIST) represent a surgical challenge. This study aims to investigate the efficacy of laparoscopic surgery and open procedure for EGJ-GIST through the propensity score matching (PSM) method. Methods: Between April 2006 and April 2018, 1824 patients underwent surgery were finally diagnosed with primary gastric GIST at four medical centers in South China. EGJ-GIST was defined as a GIST with an upper border of less than 5 cm from the EG line. Among them, 228 patients were identified and retrospectively reviewed with regard to clinicopathological characteristics, operative information and long-term outcomes. The PSM methods was used to eliminate the selection bias. Results: After PSM, 102 cases, consisted of 51 laparoscopic (LA) and 51 open surgery (OP), were enrolled. The match factors contained year of surgery, gender, age, BMI, tumor size, mitotic rate, recurrence risk and adjuvant tyrosine kinase inhibitors treatment. The LA group was superior to the OP group in operative time (108.5±56.5 vs. 169.3±79.0 min, P <0.001), blood loss (54.6±81.9 vs. 104.9±156.4 ml, P = 0.042), time to liquid intake (3.1±1.8 vs. 4.3±2.2 d, P = 0.003), hospital stay (6.0±2.3 vs. 9.9±8.1, P = 0.001), and postoperative complication (5.9% vs. 25.5%, P = 0.006). The median follow-up was 55 (range, 2-153) months in the entire cohort. No significant differences were detected in either the relapse-free survival (RFS, P = 0.109) or overall survival (OS, P = 0.113) between two groups. The 1-, 3-, and 5-year RFS in the LA and OP groups were 100.0%, 95.5%, 91.0% and 100.0%, 90.8%, 85.7%, respectively. The 1-, 3-, and 5-year OS in the LA and OP group were 100%, 95.6%, 91.3% and 100.0%, 91.1%, 85.4%, respectively. Conclusions: Laparoscopic surgery for EGJ-GIST is associated with the advantages of shorter operative time, reduced blood loss, shorter time to liquid intake and shorter length of stay, all without compromising post-operative outcomes and long-term survival.

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Laparoscopic and open surgery in rectal cancer patients in Germany: short and long-term results of a large 10-year population-based cohort

Surgical Endoscopy ◽

10.1007/s00464-019-06861-4 ◽

2019 ◽

Vol 34 (3) ◽

pp. 1132-1141 ◽

Cited By ~ 2

Author(s):

Valentin Schnitzbauer ◽

Michael Gerken ◽

Stefan Benz ◽

Vinzenz Völkel ◽

Teresa Draeger ◽

...

Keyword(s):

Rectal Cancer ◽

Laparoscopic Surgery ◽

Open Surgery ◽

Cox Regression ◽

Survival Rates ◽

Relative Survival ◽

Laparoscopic Group ◽

Cancer Registries ◽

Long Term Results

Abstract Background Rectal cancer is frequent in Germany and worldwide. Several studies have assessed laparoscopic surgery as a treatment option and most have shown favorable results. However, long-term oncologic safety remains a controversial issue. Methods The current dataset derives from 30 clinical cancer registries in Germany and includes 16,378 patients diagnosed with rectal cancer between 2007 and 2016. Outcomes were 90-day mortality, overall survival (OS), local recurrence-free survival (RFS) and relative survival of patients treated with either open or laparoscopic surgery. Multivariable logistic regression was used to evaluate factors that affected the probability of a patient undergoing laparoscopic surgery as well as to evaluate short-term mortality. OS and RFS were analyzed by Kaplan–Meier plots and multivariable Cox regression conducted separately for UICC stages I–III, tumor location, and sex as well as by propensity score matching followed by univariable and multivariable survival analysis. Results Of 16,378 patients, 4540 (27.7%) underwent laparoscopic surgery, a trend which increased during the observation period. Patients undergoing laparoscopy attained better results for 90-day mortality (odds ratio, OR 0.658, 95% confidence interval, CI 0.526–0.822). The 5-year OS rate in the laparoscopic group was 82.6%, vs. 76.6% in the open surgery group, with a hazard ratio (HR) of 0.819 in multivariable Cox regression (95% CI 0.747–0.899, p < 0.001). The laparoscopic group showed a better 5-year RFS, with 81.8 vs. 74.3% and HR 0.770 (95% CI 0.705–0.842, p < 0.001). The 5-year relative survival rates were also in favor of laparoscopy, with 93.1 vs. 88.4% (p = 0.012). Conclusion Laparoscopic surgery for rectal cancer can be performed safely and, according to this study, is associated with an oncological outcome superior to that of the open procedure. Therefore, in the absence of individual contraindications, it should be considered as a standard approach.

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Long-Term Outcomes After Laparoscopic Surgery Versus Open Surgery for Rectal Cancer: A Propensity Score Analysis

Annals of Surgical Oncology ◽

10.1245/s10434-013-2981-y ◽

2013 ◽

Vol 20 (8) ◽

pp. 2633-2640 ◽

Cited By ~ 15

Author(s):

Jun Seok Park ◽

Gyu-Seog Choi ◽

Soo Han Jun ◽

Soo Yeun Park ◽

Hye Jin Kim

Keyword(s):

Rectal Cancer ◽

Laparoscopic Surgery ◽

Propensity Score ◽

Open Surgery ◽

Propensity Score Analysis ◽

Long Term Outcomes ◽

Score Analysis

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Postoperative non-steroidal anti-inflammatory drug use and oncological outcomes of rectal cancer

BJS Open ◽

10.1093/bjsopen/zraa050 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

O Grahn ◽

M Lundin ◽

M-L Lydrup ◽

E Angenete ◽

M Rutegård

Keyword(s):

Rectal Cancer ◽

Propensity Score ◽

Propensity Score Matching ◽

Instrumental Variables ◽

Cox Regression ◽

Recurrence Free Survival ◽

Free Survival ◽

Oncological Outcomes ◽

Anti Inflammatory ◽

Instrumental Variables Approach

Abstract Background Non-steroidal anti-inflammatory drugs (NSAIDs) are known to suppress the inflammatory response after surgery and are often used for pain control. This study aimed to investigate NSAID use after radical surgical resection for rectal cancer and long-term oncological outcomes. Methods A cohort of patients who underwent anterior resection for rectal cancer between 2007 and 2013 in 15 hospitals in Sweden was investigated retrospectively. Data were obtained from the Swedish Colorectal Cancer Registry and medical records; follow-up was undertaken until July 2019. Patients who received NSAID treatment for at least 2 days after surgery were compared with controls who did not, and the primary outcome was recurrence-free survival. Cox regression modelling with confounder adjustment, propensity score matching, and an instrumental variables approach were used; missing data were handled by multiple imputation. Results The cohort included 1341 patients, 362 (27.0 per cent) of whom received NSAIDs after operation. In analyses using conventional regression and propensity score matching, there was no significant association between postoperative NSAID use and recurrence-free survival (adjusted hazard ratio (HR) 1.02, 0.79 to 1.33). The instrumental variables approach, including individual hospital as the instrumental variable and clinicopathological variables as co-variables, suggested a potential improvement in the NSAID group (HR 0.61, 0.38 to 0.99). Conclusion Conventional modelling did not demonstrate an association between postoperative NSAID use and recurrence-free survival in patients with rectal cancer, although an instrumental variables approach suggested a potential benefit.

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Assessment of Circumferential Resection Margins (CRM) clearance in Conventional open Versus Laparoscopic Cancer Rectum Resection

QJM ◽

10.1093/qjmed/hcab097.024 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ibrahim H Bayan ◽

Ahmed Abdelaziz ◽

Tarek Youssef Ahmed ◽

Mohamed Magdy

Keyword(s):

Rectal Cancer ◽

Laparoscopic Surgery ◽

Abdominal Surgery ◽

Open Surgery ◽

Laparoscopic Group ◽

Resection Margins ◽

Laparoscopy Group ◽

Surgery Group ◽

Colon And Rectal Cancer ◽

Significant Difference

Abstract Background Colon and rectal cancer represent the fourth commonest malignancy worldwide. Globally, colon and rectal cancer make up 9.4% and 10.1% in men and women of all cancers, respectively. Colon and rectal tumors are the third most common malignancy after breast and lung cancer, respectively. The main management of rectal cancer involves a multi-disciplinary team approach and an individually tailored treatment routine. Operative surgery remains the primary and definitive treatment for locally confined rectal adenocarcinoma and is the only historical and current treatment which allows for cure. Resection of the colon and rectal cancer can be done either by open surgical excision or laparoscopically. Aim of the work The objective is to compare the radicality of total mesorectal excision for rectal cancer in both open and laparoscopic surgery through the pathology report. Methods In this multicentric, prospective, comparative study, we included the pathologically established rectal cancer patients from 2 hospitals in Cairo, Egypt, Ain Shams University Hospitals and Maadi Military Hospital, Egypt between 2013 and 2016. The sample size was 40 patients divided into two groups; 20 patients for laparoscopic arm and 20 patients for the open trans-abdominal surgery. Inclusion criteria: histopathology confirmed rectal cancer, patients fit for operative resection, and with T1- T3 grades according to the preoperative evaluation. The exclusion criteria: Patients with T4 stage tumor, patients present as emergency cases and patients present with recurrence of the tumor and synchronous colonic tumors. Results The circumferential resection margins (CRM) of the mesorectum when examined pathologically after resection showed no difference between the two arms of the study with laparoscopic group specimens 3.18±1.16 mm mean, (SD) compared to 3.50±0.45 mm mean, (SD) in the open surgery group with no statistically significant difference. The longitudinal resection margins (LRM) was (5.50±1.98 mean, SD) in the laparoscopic group compared to (5.20±2.28 mean, SD) in the open conventional surgery group with no significant difference found between the two groups. Total operative time was significantly shorter in the trans-abdominal surgery group, while the hospital stay period was significantly shorter in the laparoscopy group. Laparoscopy group also showed significantly time before flatus passage, and the patients in the laparoscopy group started oral intake faster than open surgery group. Conclusion In our study, the radicality of the rectal cancer excision in both laparoscopic and traditional open surgery, showed non inferiority of the laparoscopic technique over open surgery Long-term clinical outcomes of overall survival and recurrence is the foremost parameters which should be taken in consideration for decision for laparoscopic surgery for rectal cancer. Additional follow-up results from the current trial are presently being developed, beside with records on other secondary end points, like cost effectiveness and quality of life.

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Comparison of Long-term outcomes between Lynch sydrome and sporadic colorectal cancer: a propensity score matching analysis

10.21203/rs.3.rs-130271/v1 ◽

2020 ◽

Author(s):

Yun Xu ◽

Cong Li ◽

Charlie Zhi-Lin Zheng ◽

Yu-Qin Zhang ◽

Tian-An Guo ◽

...

Keyword(s):

Colorectal Cancer ◽

Propensity Score ◽

Propensity Score Matching ◽

Control Group ◽

Sporadic Colorectal Cancer ◽

Long Term Outcomes ◽

Term Survival ◽

Long Term Survival ◽

Tumor Stages

Abstract Background Lynch syndrome (LS) is the most common hereditary colorectal cancer (CRC) syndrome. Comparison of prognosis between LS and sporadic CRC (SCRC) were rare,with conflicting results. This study aimed to compare the long-term outcomes between patients with LS and SCRC. Methods Between June 2008 and September 2018, a total of 47 patients were diagnosed with LS by genetic testing at Fudan University Shanghai Cancer Center. A 1:2 propensity score matching was performed to obtain homogeneous cohorts from SCRC group. Thereafter, 94 SCRC patients were enrolled as control group. The long-term survival rates between the two groups were compared, and the prognostic factors were also analyzed. Results The 5-year OS rate of LS group was 97.6%, which was significantly higher than of 82.6% for SCRC group (p = 0.029). The 5-year PFS rate showed no significant differences between the two groups (78.0% for LS group vs. 70.6% for SCRC patients; p = 0.262). The 5-year TFS rates in LS group was 62.1% for LS patients, which were significantly lower than of 70.6% for SCRC group (p = 0.039). By multivariate analysis, we found that tumor progression of primary CRC and TNM staging were independent risk factors for OS. Conclusion LS patients have better long-term survival prognosis than SCRC patients. Strict regular follow-up monitoring, detection at earlier tumor stages, and effective treatment are key to ensuring better long-term prognosis.

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