J Korean Surg Soc.  2012 Nov;83(5):281-287. 10.4174/jkss.2012.83.5.281.

Short-term outcomes after laparoscopic surgery following preoperative chemoradiotherapy for rectal cancer

• Ahn BH
• Lee KH
• Park JB
• Song MS
• Kim JY
• Kim JS

• KMID: 2145005
• DOI: http://doi.org/10.4174/jkss.2012.83.5.281

Abstract

PURPOSE
The safety and the feasibility of performing laparoscopic surgery for rectal cancer after preoperative chemoradiotherapy (CRT) have not yet been established. Thus, the aim of this study was to evaluate the efficacy and the safety of laparoscopic rectal cancer surgery performed after preoperative CRT.
METHODS
We enrolled 124 consecutive patients who underwent laparoscopic surgery for rectal cancer. Of these patients, 56 received preoperative CRT (CRT group), whereas 68 did not (non-CRT group). The patients who were found to have distant metastasis and open conversion during surgery were excluded. The clinicopathologic parameters were evaluated and the short-term outcomes were compared between the CRT and non-CRT groups.
RESULTS
The mean operation time was longer in the CRT group (294 minutes; range, 140 to 485 minutes; P = 0.004). In the non-CRT group, the tumor sizes were larger (mean, 4.0 cm; range, 1.2 to 8.0 cm; P < 0.001) and more lymph nodes were harvested (mean, 12.9; range, 0 to 35; P < 0.001). However, there was no significant difference between the two groups in time to first bowel movement, tolerance of a soft diet, length of hospital stay, and postoperative complication rate.
CONCLUSION
Performing laparoscopic surgery for rectal cancer after preoperative CRT may be safe and feasible if performed by a highly skilled laparoscopic surgeon. Randomized controlled trials and long-term follow-up studies are necessary to support our results.

Keyword

Rectal neoplasm; Laparoscopy; Chemoradiotherapy; Outcomes

MeSH Terms

Chemoradiotherapy
Diet
Humans
Laparoscopy
Length of Stay
Lymph Nodes
Neoplasm Metastasis
Postoperative Complications
Rectal Neoplasms

Reference

1. Laparoscopically assisted colectomy is as safe and effective as open colectomy in people with colon cancer Abstracted from: Nelson H, Sargent D, Wieand HS, et al; for the Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004; 350:2050-2059. Cancer Treat Rev. 2004. 30:707–709.

2. Colon Cancer Laparoscopic or Open Resection Study Group. Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, et al. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol. 2009. 10:44–52.

3. Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002. 359:2224–2229.

4. Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, et al. Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet. 2004. 363:1187–1192.

5. Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol. 2007. 25:3061–3068.

6. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005. 365:1718–1726.

7. Han N, Galandiuk S. Induction chemoradiation for rectal cancer. Arch Surg. 2006. 141:1246–1252.

8. Kuo LJ, Liu MC, Jian JJ, Horng CF, Cheng TI, Chen CM, et al. Is final TNM staging a predictor for survival in locally advanced rectal cancer after preoperative chemoradiation therapy? Ann Surg Oncol. 2007. 14:2766–2772.

9. Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004. 351:1731–1740.

10. Shivnani AT, Small W Jr, Stryker SJ, Kiel KD, Lim S, Halverson AL, et al. Preoperative chemoradiation for rectal cancer: results of multimodality management and analysis of prognostic factors. Am J Surg. 2007. 193:389–393.

11. Enker WE, Merchant N, Cohen AM, Lanouette NM, Swallow C, Guillem J, et al. Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specialty service. Ann Surg. 1999. 230:544–552.

12. Konishi T, Watanabe T, Kishimoto J, Nagawa H. Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance. Ann Surg. 2006. 244:758–763.

13. Marijnen CA, Kapiteijn E, van de Velde CJ, Martijn H, Steup WH, Wiggers T, et al. Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol. 2002. 20:817–825.

14. Kang SB, Park JW, Jeong SY, Nam BH, Choi HS, Kim DW, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol. 2010. 11:637–645.

15. Swedish Rectal Cancer Trial. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med. 1997. 336:980–987.

16. Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001. 345:638–646.

17. Yamamoto S, Fujita S, Akasu T, Moriya Y. Safety of laparoscopic intracorporeal rectal transection with double-stapling technique anastomosis. Surg Laparosc Endosc Percutan Tech. 2005. 15:70–74.

18. Gouvas N, Tsiaoussis J, Pechlivanides G, Tzortzinis A, Dervenis C, Avgerinos C, et al. Quality of surgery for rectal carcinoma: comparison between open and laparoscopic approaches. Am J Surg. 2009. 198:702–708.

19. Lujan J, Valero G, Hernandez Q, Sanchez A, Frutos MD, Parrilla P. Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg. 2009. 96:982–989.

20. Sileri P, Sthory R, McVeigh E, Child T, Cunningham C, Mortensen NJ, et al. Adhesions are common and costly after open pouch surgery. J Gastrointest Surg. 2008. 12:1239–1245.

21. Zhou ZG, Hu M, Li Y, Lei WZ, Yu YY, Cheng Z, et al. Laparoscopic versus open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc. 2004. 18:1211–1215.

22. Barlehner E, Benhidjeb T, Anders S, Schicke B. Laparoscopic resection for rectal cancer: outcomes in 194 patients and review of the literature. Surg Endosc. 2005. 19:757–766.

23. Leroy J, Jamali F, Forbes L, Smith M, Rubino F, Mutter D, et al. Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc. 2004. 18:281–289.

24. Morino M, Parini U, Giraudo G, Salval M, Brachet Contul R, Garrone C. Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg. 2003. 237:335–342.

25. Akiyoshi T, Kuroyanagi H, Oya M, Konishi T, Fukuda M, Fujimoto Y, et al. Safety of laparoscopic total mesorectal excision for low rectal cancer with preoperative chemoradiation therapy. J Gastrointest Surg. 2009. 13:521–525.

26. Garlipp B, Ptok H, Schmidt U, Meyer F, Gastinger I, Lippert H. Neoadjuvant chemoradiotherapy for rectal carcinoma: effects on anastomotic leak rate and postoperative bladder dysfunction after non-emergency sphincter-preserving anterior rectal resection. Results of the Quality Assurance in Rectal Cancer Surgery multicenter observational trial. Langenbecks Arch Surg. 2010. 395:1031–1038.