Comparative Study on Oncologic Results of Laparoscopic Versus Open Radical Resection for Patients with Rectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIANG Yaoze , YU Jiang , ZHANG Ce , WANG Yanan , HU Yanfeng , ZHEN Li , CHENG Xia , ZHU Zhengpeng , LI Guoxin

Department of General Surgery, Nanfang Hospital, Nanfang Medical University, Guangzhou 510515, China;

Corresponding author：

Keywords：

Rectal cancer; Laparoscopy; Survival analysis

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Objective To compare the oncologic results between laparoscopic and open approach for the treatment of rectal cancer. Methods Five hundred and twenty patients with rectal cancer from Jan. 2003 to Dec. 2008 were non-randomly divided into laparoscopic (LS) and open surgery (OS) group. Local recurrence, distant metastasis and survival rate were compared between two groups. Results One hundred and eighty-six cases received laparoscopic resection and 334 cases received open operation. There were no statistically significant differences (SSD) of demographic data between two groups (P gt;0.05). Mean follow-up was 30.3 months. No SSD was observed in 3-year cumulative survival rate (83% in LS and 80% in OS, P=0.549), distant metastasis rate (12.5% in LS and 15.6% in OS, P=0.368), incidence of incision seeding (0.6% in LS and 0 in OS, P=0.189), or cumulative survival (P=0.142). The differences of local recurrences rate (4.8% in LS and 10.7% in OS, P=0.028), 3-year cumulative disease-free survival rate (81% in LS and 68% in OS, P=0.009), and cumulative disease-free survival (P=0.010) between two groups were statistical significant. The differences of cumulative survival, cumulative disease-free survival, local recurrences， and distant metastasis according to the TNM stageⅠ or Ⅱ between two groups were not statistical significant. The differences of cumulative disease-free survival and local recurrences according to the TNM stage Ⅲ reached statistical significance (P=0.045 and P=0.047, respectively). Conclusion Oncologic results of laparoscopic resection are similar to those of open resection for rectal carcinoma．

Citation： LIANG Yaoze,YU Jiang,ZHANG Ce,WANG Yanan,HU Yanfeng,ZHEN Li,CHENG Xia,ZHU Zhengpeng,LI Guoxin. Comparative Study on Oncologic Results of Laparoscopic Versus Open Radical Resection for Patients with Rectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(6): 591-595. doi: Copy

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2.	Morino M, Allaix ME, Giraudo G, et al. Laparoscopic versus open surgery for extraperitoneal rectal cancer: a prospective comparative study[J]. Surg Endosc, 2005; 19(11): 1460-1467.
3.	Ahmad Assalia, Michel Gagner, Moshe Schein. Controversies in laparoscopic surgery [M]. Springer, 2007: 318-319.
4.	范莹, 吴硕东, 于宏, 等. 腹腔镜结直肠癌根治术与同期开腹手术对比的单中心回顾性研究 [J]. 中国普外基础与临床杂志, 2009; 16(5): 384-388.
5.	于永扬, 杨烈, 周总光, 等. 腹腔镜全直肠系膜切除保肛术后生活质量评估 [J]. 中国普外基础与临床杂志, 2007; 14(5): 524-529.
6.	Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer[J]. N Engl J Med, 2004; 350(20): 2050-2059.
7.	汪建平. 重视结直肠外科手术患者术后生存质量的提高 [J]. 中国普外基础与临床杂志, 2007; 14(6): 625-627.
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10.	牟一平, 杨鹏, 严加费, 等. 腹腔镜结肠癌根治术的临床疗效评估 [J]. 中华外科杂志, 2006; 44(9): 581-583.
11.	Lacy AM, García-Valdecasas JC, Delgado S, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial [J]. Lancet, 2002; 359(9325): 2224-2229.
12.	Ng SS, Leung KL, Lee JF, et al. Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial [J]. Ann Surg Oncol, 2008; 15(9): 2418-2425.
13.	Moore E, Heald RJ, Cecil TD, et al. Almost all five year disease free survivors are cured following rectal cancer surgery, but longer term follow-up detects some late local and systemic recurrences [J]. Colorectal Dis, 2005; 7(4): 403-405.
14.	池畔, 林惠铭, 陈燕昌, 等. 两种直肠癌根治术应用于全直肠系膜切除术后局部复发率的比较 [J]. 中华外科杂志, 2002; 40(11): 820-821.
15.	郑民华, 胡艳艳, 陆爱国, 等. 腹腔镜与开腹直肠全系膜切除术治疗低位直肠癌的临床对比研究 [J]. 中华胃肠外科杂志, 2004; 7(3): 177-180.
16.	Enker WE. Mesorectal excision (TME) in the operative treatment of rectal cancer [J]. Int J Surg Investig, 1999; 1(3): 253-255.
17.	郑民华, 马君俊. 腹腔镜外科在争议中发展 [J].中国普外基础与临床杂志, 2007; 14(5): 503-505.
18.	吴东波, 黄顺荣, 吴鸿根, 等. 改良腹腔镜Dixon手术和开腹Dixon手术的临床对照研究(附58例报道) [J].中国普外基础与临床杂志, 2009; 16(3): 211-214.
19.	Sargent D, Wieand S, Goldberg R, et al． 3-Year DFS vs 5-year OS as an endpoint for adjuvant colon cancer studies: data from randomized trials. Rockville, Md: Food and Drug Administration. November 2003(Accessed May 10, 2004, at. http:// www.fda.gov/cder/drug/cance_endpoints/ Sargent/index.htm).
20.	Hartley JE, Mehigan BJ, MacDonald AW, et al. Patterns of recurrence and survival after laparoscopic and conventional resections for colorectal carcinoma [J]. Ann Surg, 2000; 232(2): 181-186.
21.	赵刚, 肖刚, 黄雄, 等. 腹腔镜结直肠癌根治对机体免疫状态的影响 [J]. 中华胃肠外科杂志, 2005; 8 (5): 407-409.

1. Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial[J]. Lancet, 2005; 365(9472): 1718-1726.
2. Morino M, Allaix ME, Giraudo G, et al. Laparoscopic versus open surgery for extraperitoneal rectal cancer: a prospective comparative study[J]. Surg Endosc, 2005; 19(11): 1460-1467.
3. Ahmad Assalia, Michel Gagner, Moshe Schein. Controversies in laparoscopic surgery [M]. Springer, 2007: 318-319.
4. 范莹, 吴硕东, 于宏, 等. 腹腔镜结直肠癌根治术与同期开腹手术对比的单中心回顾性研究 [J]. 中国普外基础与临床杂志, 2009; 16(5): 384-388.
5. 于永扬, 杨烈, 周总光, 等. 腹腔镜全直肠系膜切除保肛术后生活质量评估 [J]. 中国普外基础与临床杂志, 2007; 14(5): 524-529.
6. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer[J]. N Engl J Med, 2004; 350(20): 2050-2059.
7. 汪建平. 重视结直肠外科手术患者术后生存质量的提高 [J]. 中国普外基础与临床杂志, 2007; 14(6): 625-627.
8. 直肠癌临床实践指南 2009年(美国版), Http://www.NCCN.com.
9. 郑民华. 腹腔镜结肠癌根治术的原则与评价 [J]. 中华外科杂志, 2005; 43(17): 1105-1106.
10. 牟一平, 杨鹏, 严加费, 等. 腹腔镜结肠癌根治术的临床疗效评估 [J]. 中华外科杂志, 2006; 44(9): 581-583.
11. Lacy AM, García-Valdecasas JC, Delgado S, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial [J]. Lancet, 2002; 359(9325): 2224-2229.
12. Ng SS, Leung KL, Lee JF, et al. Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial [J]. Ann Surg Oncol, 2008; 15(9): 2418-2425.
13. Moore E, Heald RJ, Cecil TD, et al. Almost all five year disease free survivors are cured following rectal cancer surgery, but longer term follow-up detects some late local and systemic recurrences [J]. Colorectal Dis, 2005; 7(4): 403-405.
14. 池畔, 林惠铭, 陈燕昌, 等. 两种直肠癌根治术应用于全直肠系膜切除术后局部复发率的比较 [J]. 中华外科杂志, 2002; 40(11): 820-821.
15. 郑民华, 胡艳艳, 陆爱国, 等. 腹腔镜与开腹直肠全系膜切除术治疗低位直肠癌的临床对比研究 [J]. 中华胃肠外科杂志, 2004; 7(3): 177-180.
16. Enker WE. Mesorectal excision (TME) in the operative treatment of rectal cancer [J]. Int J Surg Investig, 1999; 1(3): 253-255.
17. 郑民华, 马君俊. 腹腔镜外科在争议中发展 [J].中国普外基础与临床杂志, 2007; 14(5): 503-505.
18. 吴东波, 黄顺荣, 吴鸿根, 等. 改良腹腔镜Dixon手术和开腹Dixon手术的临床对照研究(附58例报道) [J].中国普外基础与临床杂志, 2009; 16(3): 211-214.
19. Sargent D, Wieand S, Goldberg R, et al． 3-Year DFS vs 5-year OS as an endpoint for adjuvant colon cancer studies: data from randomized trials. Rockville, Md: Food and Drug Administration. November 2003(Accessed May 10, 2004, at. http:// www.fda.gov/cder/drug/cance_endpoints/ Sargent/index.htm).
20. Hartley JE, Mehigan BJ, MacDonald AW, et al. Patterns of recurrence and survival after laparoscopic and conventional resections for colorectal carcinoma [J]. Ann Surg, 2000; 232(2): 181-186.
21. 赵刚, 肖刚, 黄雄, 等. 腹腔镜结直肠癌根治对机体免疫状态的影响 [J]. 中华胃肠外科杂志, 2005; 8 (5): 407-409.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparative Study on Oncologic Results of Laparoscopic Versus Open Radical Resection for Patients with Rectal Cancer

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