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Laparoscopic surgery for rectal cancer: preoperative radiochemotherapy versus surgery alone.
- Source :
-
Surgical endoscopy [Surg Endosc] 2012 Jul; Vol. 26 (7), pp. 1878-83. Date of Electronic Publication: 2012 Jan 05. - Publication Year :
- 2012
-
Abstract
- Background: A few studies have suggested advantages of laparoscopic surgery for rectal cancer. However, the role of laparoscopy has not been clearly defined specifically in cases after neoadjuvant radiochemotherapy. This study aimed to assess the impact of preoperative radiotherapy on the feasibility of laparoscopic rectal excision with sphincter preservation for rectal cancer.<br />Methods: From 1999 to 2010, the authors considered all patients treated by laparoscopic rectal excision with sphincter preservation for rectal cancer. Patients treated by long-course preoperative radiochemotherapy (45 Gy during 5 weeks) were compared with those treated by surgery alone. The end points of the study were mortality, conversion, and overall and surgical morbidity.<br />Results: Among 422 patients treated by laparoscopic conservative rectal excision, 292 received preoperative radiotherapy, and 130 had surgery alone. The two groups were similar in sex, age, body mass index, and American Society of Anesthesiologists (ASA) score. The mortality rate was 0.3% in the radiotherapy group and 0.8% in the surgical group (P = 0.52). The two groups did not differ in terms of conversion (19 vs. 15%; P = 0.39), overall morbidity (37 vs. 29%; P = 0.14), surgical morbidity (20 vs. 18%; P = 0.60), or anastomotic leakage (13 vs. 11%; P = 0.54). Multivariate analysis showed male gender and synchronous metastasis as independent factors of surgical morbidity. The independent factors of conversion were male gender, obesity, tumor stage, and type of anastomosis. Preoperative radiotherapy influenced neither conversion nor surgical morbidity.<br />Conclusion: Long-course radiochemotherapy does not have an impact on the feasibility or short-term outcome of laparoscopic conservative rectal excision for rectal cancer.
- Subjects :
- Adult
Aged
Aged, 80 and over
Chemoradiotherapy, Adjuvant mortality
Feasibility Studies
Female
Humans
Intraoperative Complications etiology
Intraoperative Complications surgery
Laparoscopy mortality
Male
Middle Aged
Postoperative Complications mortality
Preoperative Care methods
Preoperative Care mortality
Rectal Neoplasms mortality
Treatment Outcome
Young Adult
Adenocarcinoma therapy
Chemoradiotherapy, Adjuvant methods
Laparoscopy methods
Rectal Neoplasms therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1432-2218
- Volume :
- 26
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Surgical endoscopy
- Publication Type :
- Academic Journal
- Accession number :
- 22219008
- Full Text :
- https://doi.org/10.1007/s00464-011-2119-x