A Comparison on Efficacy Between Laparoscopic and Open Radical Resection of Rectal Cancer / 中国微创外科杂志

ABSTRACT

Objective To investigate the efficacy and safety of laparoscopic surgery of rectal cancer for different stages of rectal cancer . Methods A retrospective analysis was made on clinical data of 96 cases of rectal cancer from January 2009 to December 2013.Among 42 cases of TNM staged 0-Ⅰ, there were 22 cases of laparoscopic surgery ( laparoscopic group A ) and 20 cases of open surgery ( laparotomy group A ) .Among 54 cases of TNM staged Ⅱ-Ⅲ, there were 20 cases of laparoscopic surgery (laparoscopic group B) and 34 cases of open surgery (laparotomy B group).At the end of follow-up ended in May 2015, the tumor markers, postoperative complications , local recurrence , distant metastasis rate and 1-year and 3-year survival rates were compared in different stages of patients between the laparoscopic surgery and open surgery . Results As compared with the laparotomy group A , the laparoscopic group A had shorter surgery time [(121.7 ±13.5) min vs.(142.4 ±23.5) min, t=-3.530, P=0.000] and less blood loss [(80.9 ±10.6) ml vs.(136.3 ±32.6), t=-7.559, P=0.000].As compared with the laparotomy group B , the laparoscopic group B had less blood loss [(110.3 ±15.3) ml vs.(186.5 ±22.6) ml, t=-12.202, P=0.000].As compared with the laparotomy group A, the laparoscopic group A had significantly reduced distal resection margin distance [(2.3 ±0.6) cm vs. (3.0 ±0.7) cm, t=-3.489, P=0.001].As compared with the laparotomy group B, the number of lymph node metastasis was significantly reduced in the laparoscopic group B (2.7 ±0.4 vs.3.1 ±0.4, t =-3.298, P=0.002).The conversion rate to laparotomy in the laparoscopic group B was 20%.There were no significant difference between the laparoscopic group A and laparotomy group A in local recurrence rate [9.5% (2/21) vs.5.0% (1/20), χ2 =0.000, P=1.000], distant metastasis rate [4.8%(1/21) vs.5.0%(1/20),χ2 =0.000, P=1.000], and survival rate (log-rankχ2 =0.102, P=0.750).There were no significant difference between the laparoscopic group B and laparotomy group B in local recurrence rate [6.2%(1/16) vs.6.2%(2/32),χ2 = 0.000, P=1.000], distant metastasis rate [6.2%(1/16) vs.3.1%(1/32), Fisher test, P=1.000], and survival rate (log-rankχ2 =0.158, P=0.691). Conclusions Laparoscopic radical surgery for TNM stage 0-Ⅰ of rectal cancer has a good effect and safety.The conversion rate to laparotomy in TNM staged Ⅱ-Ⅲrectal cancer patients is still high with relatively high surgical risks , which requires strict preoperative assessment .