Laparoscopic surgery for rectal cancer reveals comparable oncological outcome even in context of worse short-term results—long-term analysis of nearly 500 patients from two high-volume centers

Markus Zimmermann, Susanne Merkel, Klaus Weber, Hans Peter Bruch, Werner Hohenberger, Tobias Keck*, Robert Grützmann

*Corresponding author for this work

Abstract

Purpose: Large randomized controlled trials have investigated the oncological value of the laparoscopic approach to colorectal cancer. Mainly, non-inferiority for the laparoscopic approach regarding long-term survival could be shown. Nevertheless, some recent trials revealed inferiority especially due to histopathological quality of specimen or location of the tumor in the rectum. The main objective of this study was to compare two historical patient collectives of specialized centers for either the laparoscopic or the open resection approach, regarding long-term survival and disease progression of rectal cancer according to tumor localization in a retrospective propensity score–matched analysis. Methods: A retrospective analysis, based on two prospectively maintained institutional colorectal cancer databases, was performed. The database of the reference center in Erlangen maintained almost exclusively open operations whereas the database in Lübeck maintained to a vast majority laparoscopic operations. To adjust risk profiles, a 1:1 propensity score matching was performed. Results: Seven hundred fifty-five patients of both centers (Erlangen, n = 507, Lübeck n = 248) were included. Propensity score matching resulted in two equalized groups with 248 patients. Regarding the postoperative complications, advantages for the open approach were seen. Analyzing the survival data, no differences in disease-free as well as overall survival were shown. Also, no differences in the overall loco-regional recurrence and distant metastasis rate were detected. Conclusion: In centers with adequate expertise, open and laparoscopic procedures result in equivalent oncologic long-term outcomes. Advantages for the open resected group concerning short-term results and complications were detected, due to remarkably low rates of anastomotic leakage.

Original languageEnglish
JournalInternational Journal of Colorectal Disease
Volume34
Issue number9
Pages (from-to)1541-1550
Number of pages10
ISSN0179-1958
DOIs
Publication statusPublished - 01.09.2019

Research Areas and Centers

  • Research Area: Luebeck Integrated Oncology Network (LION)

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