Comparison between the oncologic outcome of laparoscopic surgery and open surgery for T1 and T2 rectosigmoidal and rectal carcinoma: matched case-control study.

BACKGROUND/AIMS: The long-term outcome of laparoscopic resection (Lap-R) of rectal cancer is still unclear. The purpose of this study was to elucidate the validity of Lap-R by comparing the short-term and mid-term outcome of Lap-R performed in our hospital to treat T1 and T2 rectal cancer patients with that of patients with the same clinicopathological background treated for rectal cancer by open surgery (O-R). METHODOLOGY: We conducted a matched case-control study of the oncologic outcome of T1 and T2 rectal cancer patients who had undergone Lap-R between 1996 and 2002 by matching them for sex, age, location, and TNM classification with patients who underwent O-R during the same period, and the total number of subjects in both groups combined was 76. RESULTS: The median follow-up period in the Lap-R group was 36 months, as opposed to 58 months in the O-R group. There were no operative deaths in either group. Comparison of the postoperative complications showed that intraoperative blood loss was significantly less in the Lap-R group than in the O-R group (P < 0.0001), and there were fewer cases of intestinal obstruction (p = 0.0312). The number of postoperative hospital days was also significantly shorter (p = 0.00046). The overall survival rate was 91.6% in the Lap-R group and 92.7% in the O-R groups, and the difference was not significant (p = 0.5306). The recurrence-free survival rate was 96.7% in the Lap-R group and 82.4% in the O-R group, and the difference was not significant (p = 0.4587). The difference in recurrence rate between the groups was not significant (p = 0.446), and there were no differences in modes of recurrence, but local recurrence was the most common mode in both groups. No recurrences were observed at the site of the port in the Lap-R group. CONCLUSIONS: When we performed our matched case-control study of Lap-R and O-R as surgical procedures for T1 and T2 rectal cancer, Lap-R was less invasive based on the short-term outcome. Moreover, there were no significant differences in mode of recurrence or recurrence rate, and no significant difference between the two groups was observed in oncologic outcome. It will be necessary to await the results of both Japanese and international randomized controlled trials (RCT). However, short- and mid-term follow-up of identical patients at a single institution as in the present study also appeared to have sufficient significance.

Comparison of long-term outcome of laparoscopic and conventional surgery for advanced colon and rectosigmoid cancer.

BACKGROUND/AIMS: Although after laparoscopic surgery for colorectal cancer postoperative recovery is better than after open surgery, oncologic outcome after this minimally invasive technique remains unclear. In this study we tested the null hypothesis that there is no difference in the outcome of advanced colorectal cancer according to whether it is treated by laparoscopic or conventional open resection. METHODOLOGY: The long-term outcome of 79 patients with advanced colorectal cancer who underwent laparoscopic surgery between 1996 and 2002 was compared with that of 79 who underwent open surgery during the same period, being well-matched patients for age, gender, tumor site, and pathological TNM stage (II or III). Adjuvant therapy and postoperative follow-up were the same in both groups. RESULTS: The median follow-up time after laparoscopic and open surgery was 36 months and 47 months, respectively (p = 0.0756). No significant difference was found between the groups in overall or disease-free survival rates (96% versus 88%, p = 0.12; 96% versus 86%, p = 0.09, respectively). The recurrence rate was 23% in both groups, and liver metastasis was the most frequent form of recurrence. No port site recurrence was observed in the laparoscopic surgery group. CONCLUSIONS: The laparoscopic approach is an acceptable alternative to open surgery for advanced colorectal cancer because of the comparable medium-term outcome. Longer follow-up and large scale RCT is needed to fully assess the oncologic outcome.