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Laparoscopic surgery for the curative treatment of rectal cancer: results of a Chinese three-center case–control study

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Abstract

Background

This study aimed to assess the efficacy and safety of laparoscopic resection (LR) for rectal cancer.

Methods

A case-control study involving three Chinese medical centers was conducted. Rectal cancer patients undergoing LR were compared with open resection (OR) cases simultaneously from January 2004 to December 2005. Data were collected, and basic characteristics, conversion rate, recovery, complications, adjuvant therapy, and recurrence rate were compared. Analysis was by intention to treat.

Results

A total of 335 rectal cancer procedures (115 LR and 220 OR) met the inclusion criteria. The patients’ basic characteristics were similar in the two groups (p > 0.05). Total mesorectal excision was performed for 85.59% of the patients (201/235), who received anal sphincter preservation. Compared with OR, LR had a shorter incision length, less blood loss, and less need for transfusion, but the operation time was longer (p < 0.05). No significant differences were observed between the two groups in positive rates of longitudinal resection margins, numbers of harvested lymph nodes, complication rates during operation and postoperation, and perioperative reoperation and morbidity rates (p > 0.05). Postoperative parenteral narcotics were used less in LR than in OR (47.8% vs 62.7%; χ2 = 6.867; p = 0.009). The median time until first flatus; resumption of diet, defecation, micturition, and ambulation; and discharge were reduced in LR (p < 0.05). Conversion from LR to OR was required by 11.3% of the patients (13/115). The intraoperative complication rate was 30.8% for the patients who underwent conversion. The operation time and postoperative complication rate were the same as for LR alone (p > 0.05). The local recurrence rate was 3.7% for the LR group and 4.9% for the OR group (χ 2 = 0.209; p = 0.647) during the 20-month median follow-up period.

Conclusions

The findings showed that LR for rectal cancer was safe and effective, resulting in faster recovery and a similar complication rate compared with OR. Conversion did not alter the patients’ outcomes.

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Acknowledgment

This work was supported by the Natural Science Foundation of Zhejiang province, China (Grant No. X206953).

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Authors and Affiliations

  1. Department of Surgical Oncology, Second Affiliated Hospital, The Key Laboratory of Cancer Prevention and Intervention, Zhejiang University College of Medicine, 88 Jiefang Road, Hangzhou, 310009, China

    Ke-Feng Ding, Jun Li, Xiao-Chen Wang, Li-Feng Sun, Jian-Wei Wang, Shu Zheng & Su-Zhan Zhang

  2. Department of Anus and Large Intestine, Second Affiliated Hospital, Wenzhou Medical College, Wenzhou, 325027, China

    Rong Chen & Yong-Qiang Xu

  3. Department of General Surgery, Affiliated Hospital, Qingdao University, Qingdao, 266003, China

    Jian-Li Zhang & Liang Lv

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  1. Ke-Feng Ding
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Correspondence to Su-Zhan Zhang.

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Ding, KF., Chen, R., Zhang, JL. et al. Laparoscopic surgery for the curative treatment of rectal cancer: results of a Chinese three-center case–control study. Surg Endosc 23, 854–861 (2009). https://doi.org/10.1007/s00464-008-9990-0

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  • DOI: https://doi.org/10.1007/s00464-008-9990-0

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