Results of laparoscopic resection in high-risk rectal cancer patients
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ORIGINAL ARTICLE
Results of laparoscopic resection in high-risk rectal cancer patients Sofoklis Panteleimonitis 1,2
&
Nuno Figueiredo 3 & Thakshyanee Bhunakrishna 2 & Mick Harper 1 & Amjad Parvaiz 1,2,3
Received: 19 March 2020 / Accepted: 3 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Obesity, neoadjuvant-radiotherapy, tumour proximity to the anal verge and previous abdominal surgery are factors that might increase the intra-operative difficulty of laparoscopic rectal cancer surgery. However, whether patients with these ‘highrisk’ characteristics are subject to worse short- or long-term outcomes is debated. The aim of this study is to examine the shortand long-term clinical and oncological outcomes of patients receiving laparoscopic rectal surgery with any of these high-risk characteristics and compare them with patients that do not possess any of these high-risk features. Methods For the purpose of this study data from consecutive patients receiving laparoscopic rectal cancer resections between 2006 and 2016 from two centres were analysed. High-risk patients were defined as patients with either one of the following characteristics: BMI ≥ 30, neoadjuvant chemoradiotherapy, tumour < 8 cm from the anal verge and previous abdominal surgery. Results A total of 313 patients were identified (227 high risk, 86 low risk). Short-term outcomes were similar between the two groups with the exception of blood loss and length of stay, which were higher in the high-risk group (10 vs 2.5 ml, p = 0.045; 7 vs 5 days, p = 0.001). There were no statistically significant differences in 5-year overall survival (79.7% vs 79.8%, p = 0.757), disease-free survival (76.8% vs 69.3%, p = 0.175), distant disease-free interval (84.8% vs 79.7%, p = 0.231) and local recurrencefree interval (100%, 97.4%, p = 0.162) between the two groups. Conclusion Similar short- and long-term outcomes can be achieved in high-risk and low-risk patients receiving laparoscopic rectal surgery. The presented data support the suitability of laparoscopic surgery for this group of patients. Keywords Minimally invasive surgery . Laparoscopy . Rectal cancer . High risk
Introduction Laparoscopic surgery has become the ‘gold standard’ for colorectal resections in the developed world with its benefits such as shorter hospital stay, less postoperative pain, early mobilisation and improved cosmesis being well established [1–6]. Two recent randomised control trials (ACOSOG Z6051 [7] and ALaCaRT [8]) examining the role of minimally invasive surgery (MIS) in rectal cancer resections have raised questions as to oncological equivalency to open surgery. Nevertheless, equivalence is supported as similar localrecurrence rates and disease-free survival have been * Sofoklis Panteleimonitis [email protected] 1
University of Portsmouth, School of Health and Care Professions, St Andrews Court, St Michael’s road, Portsmouth PO1 2PR, UK
2
Poole Hospital NHS Trust, Longfleet road, Poole BH15 2JB, UK
3
Champalimaud Foundation, Av. Brasil
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