Are oncological long-term outcomes equal after laproscopic completed and converted laparoscopic converted rectal resecti
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ORIGINAL ARTICLE
Are oncological long‑term outcomes equal after laproscopic completed and converted laparoscopic converted rectal resection for cancer? M. Finochi1 · B. Menahem1,2,3 · G. Lebreton1,2,3 · J. Lubrano1,2,3 · Y. Eid1 · A. Alves1,2,3 Received: 23 March 2020 / Accepted: 18 August 2020 © Springer Nature Switzerland AG 2020
Abstract Background The aim of this study was to compare long-term survival after laproscopic completed and laparoscopic converted rectal resection for cancer. Methods All consecutive patients who underwent curative laparoscopic rectal surgery for cancer at our institution between January 2001 and December 2016 were included in a single-center retrospective study. Patients were divided into two groups: the converted (CONV) group and the totally laparoscopic (LAP) group. The primary outcomes were long-term oncologic outcomes including overall survival (OS) and disease-free survival (DFS), as well as local and distant recurrence (LR, DR). The secondary outcomes included postoperative mortality and morbidity as defined as death or any complication occurring within 90 days postoperatively. Results Of 214 consecutive patients included, 57 were converted to open surgery (CONV group), leading to a 26.6% conversion rate. Mean length of follow-up was 68 ± 42 months in the LAP group and 70 ± 41 months in the CONV group. Five-year OS was significantly shorter in the CONV group compared to the LAP group (p = 0.0016). On multivariate analysis, rectal tumor location (middle and low) and conversion to open surgery were predictors of both OS and DFS. Conclusions This study suggests that conversion to open surgery after laparoscopic rectal resection appears to significantly reduce OS without having a significant impact on DFS and recurrence rates. Keywords Rectal cancer · Anastomotic leakage · Overall survival
Introduction Although recent guidelines in France emphasize a laparoscopic approach for rectal cancer surgery [1], evidence for minimally invasive techniques in rectal cancer is still controversial [2–9]. One of the main drawback of laparoscopic rectal surgery concerns the high prevalence of conversion to open surgery which ranges from 12 to 50% in the literature [10–20]. Its impact on long-term oncological outcomes has * B. Menahem menahem‑b@chu‑caen.fr 1
Department of Digestive Surgery, University Hospital of Caen, Avenue de La côte de Nacre, 14032 Caen Cedex, France
2
ANTICIPE INSERM U, Centre François Baclesse, 1086, Avenue du Général Harris, Caen, France
3
Pôle de Formation Et de Recherche en santé, Caen, France
not been thoroughly investigated. To date it remains unclear if conversion to open surgery leads to worse long-term outcomes after laparoscopic rectal cancer surgery. There may be several reasons for these contradictory findings. First, most studies according to a recent meta-analysis, have included both colon and rectal cancers leading to statistical bias [10, 20]. Second, the impact of conversion to open surgery has been specifically assessed only by non-rand
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