Influence of tumor location on short- and long-term outcomes after laparoscopic surgery for rectal cancer: a propensity score matched cohort study

Abstract Background: This study aimed to evaluate the short- and long-term outcomes after laparoscopic resection for low rectal cancer (LRC) compared with mid/high rectal cancer (M/HRC). Methods: Patients with rectal cancer undergoing laparoscopic resection with curative intent were retrospectively reviewed between 2009 and 2015. After matched 1:1 by using propensity score analysis, perioperative and oncological outcomes were compared between LRC and M/HRC groups. Multivariate analysis was performed to identify independent factors of overall survival (OS) and disease-free survival (DFS). Results: Of 373 patients who met the criteria for inclusion, 260 patients were matched for the analysis. Laparoscopic surgery for LRC required longer operative time (P＜0.001) and more blood loss volume (P＜0.001) compared with M/HRC, and the LRC group tended to have a higher incidence of postoperative complications (18.5% vs. 10.0%, P=0.051). There was no significant difference in local recurrence between the two groups (6.2% vs. 2.3%, P=0.216), whereas distant metastasis was more frequent in LRC patients compared with M/HRC (19.2% vs. 9.2%, P=0.021). The LRC group showed significantly inferior 5-year OS (78.1% vs. 88.8%, P=0.008) and DFS (76.2% vs. 89.0%, P=0.004) compared with the M/HRC group. Multivariate analysis indicated that tumor location was an independent predictor of OS (HR=2.095, 95% CI 1.142-3.843, P=0.017) and DFS (HR=2.320, 95% CI 1.251-4.303, P=0.008). Conclusion: Tumor location of the rectal cancer significantly affected the clinical and oncological outcomes after laparoscopic surgery, and it was an independent predictor of OS and DFS.

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Influence of Tumor Location on Short- and Long-Term Outcomes After Laparoscopic Surgery for Rectal Cancer: A Propensity Score Matched Cohort Study

10.21203/rs.3.rs-22037/v3 ◽

2020 ◽

Author(s):

Hong Yang ◽

Zhendan Yao ◽

Ming Cui ◽

Jiadi Xing ◽

Chenghai Zhang ◽

...

Keyword(s):

Rectal Cancer ◽

Multivariate Analysis ◽

Laparoscopic Surgery ◽

Laparoscopic Resection ◽

Independent Predictor ◽

Tumor Location ◽

Long Term Outcomes ◽

Oncological Outcomes ◽

Short And Long Term

Abstract Background: This study aimed to evaluate the short- and long-term outcomes after laparoscopic resection for low rectal cancer (LRC) compared with mid/high rectal cancer (M/HRC). Methods: Patients with rectal cancer undergoing laparoscopic resection with curative intent were retrospectively reviewed between 2009 and 2015. After matched 1:1 by using propensity score analysis, perioperative and oncological outcomes were compared between LRC and M/HRC groups. Multivariate analysis was performed to identify independent factors of overall survival (OS) and disease-free survival (DFS). Results: Of 373 patients who met the criteria for inclusion, 198 patients were matched for the analysis. Laparoscopic surgery for LRC required longer operative time (P＜0.001) and more blood loss volume (P=0.015) compared with M/HRC, and the LRC group tended to have a higher incidence of postoperative complications (16.2% vs. 8.1%, P=0.082). There was no significant difference in local recurrence between the two groups (9.1% vs. 4.0%, P=0.251), whereas distant metastasis was inclined to be more frequent in LRC patients compared with M/HRC (21.2% vs. 12.1%, P=0.086). The LRC group showed significantly inferior 5-year OS (77.0% vs. 86.4%, P=0.033) and DFS (71.2% vs. 86.2%, P=0.017) compared with the M/HRC group. Multivariate analysis indicated that tumor location was an independent predictor of DFS (HR=2.305, 95% CI 1.203-4.417, P=0.012). Conclusion: Tumor location of the rectal cancer significantly affected the clinical and oncological outcomes after laparoscopic surgery, and it was an independent predictor of DFS.

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