Laparoscopic rectal resection for cancer: effects of conversion on short-term outcome and survival
| Autor: | Antonino Spinelli, Riccardo Rosati, Marco Montorsi, Paolo Pietro Bianchi, Matteo Rottoli, Ugo Elmore, Cristina Bartolucci, Stefano Bona |
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| Přispěvatelé: | Rottoli, Matteo, Bona, Stefano, Rosati, Riccardo, Elmore, Ugo, Bianchi, Paolo P., Spinelli, Antonino, Bartolucci, Cristina, Montorsi, Marco, M., Rottoli, S., Bona, U., Elmore, P. P., Bianchi, A., Spinelli, C., Bartolucci, M., Montorsi |
| Rok vydání: | 2008 |
| Předmět: |
Male
medicine.medical_specialty CARCINOMA IMPACT chemical and pharmacologic phenomena COLORECTAL-CANCER Conversion to open surgery Surgical oncology WOUND RECURRENCE Medicine Humans Rectal resection MRC CLASICC TRIAL Colectomy Aged CONSEQUENCES Rectal Neoplasm business.industry Rectal Neoplasms COLON-CANCER fungi Cancer ASSISTED COLECTOMY Middle Aged medicine.disease Total mesorectal excision Survival Analysis RANDOMIZED-TRIAL Neoadjuvant Therapy Surgery Treatment Outcome Oncology OPEN SURGERY Circumferential resection margin Female Laparoscopy Survival Analysi business Human |
| Zdroj: | Annals of surgical oncology. 16(5) |
| ISSN: | 1534-4681 |
| Popis: | Background: Laparoscopic rectal resection (LRR) is an oncologically safe procedure. The impact of conversion to open surgery on outcomes has not been fully elucidated. The aim of the study is to compare short- and long-term outcomes of converted (CR) and not converted (NCR) patients undergoing LRR. Methods: Data were drawn from a prospective database of LRR performed between 1999 and 2008. Statistical analysis employed the chi-squared or Wilcoxon test and Kaplan-Meier estimation. Results: Of 173 patients undergoing LRR, 26 (15%) required conversion. No differences in age, gender, American Society of Anesthesiologists (ASA) score, and T and N stages were observed between CR and NCR patients. Conversion was associated with higher body mass index (BMI) (27.3 versus 24.9 kg/m2, P < 0.001) and American Joint Committee on Cancer (AJCC) stage IV (26.9% versus 4.8%, P < 0.001), and resulted in longer operative time (342 versus 285 min, P = 0.006) and increased intraoperative complication rate (31% versus 5%, P < 0.001). No differences were observed in postoperative outcome between CR and NCR patients. After a mean follow-up of 46 and 36 months, 5-year disease-free survival was 55.7% in CR group and 79.2% in NCR group (P = 0.007). After exclusion of stage IV patients from the analysis, 5-year disease-free survival was 71.1% in CR group and 85.3% in NCR group (P = 0.17), while the overall recurrence rate was 26.3% in CR patients and 11.4% in NCR patients (P = 0.07). Conclusions: Our study suggests that conversion to open surgery does not affect postoperative outcome, but could have a negative impact on long-term overall recurrence rate. LRR should be performed by experienced surgeons in selected patients. © 2009 Society of Surgical Oncology. |
| Databáze: | OpenAIRE |
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