Radical Resection of Rectal Cancer: Comparison of Postoperative Complications Following Laparoscopic and Open Surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 QINHua-bo ,  XIEMing-hao , LIANLei , HEXiao-sheng , WUXiao-jian ,  LANPing ,  WANGJian-ping

Department of Colorectal Surgery, The Six Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China;

Corresponding author：

LANPing, Email: lanping@mail.sysu.edu.cn; WANGJian-ping, Email: wangjpgz@126.com

Keywords：

Rectal cancer; Radical resection; Laparoscopic surgery; Open surgery; postoperative complications

DOI：

10.7507/1007-9424.20150142

Video：

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Objective To compare the postoperative complications following laparoscopic and open radical resection for rectal cancer. Methods The clinical data of 681 patients with rectal cancer from January 2011 to December 2014 in the Sixth Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively, of whom 583 patients underwent laparoscopic surgery (laparoscopic group) and 98 patients underwent open surgery (open group). The complications were compared between the two groups. Results ①There were no statistically significant differences in the gender, age, total protein, albumin, and body mass index between the two groups (P > 0.05). As compared with the open group, the proportions of previous abdominal operation, Dixon operation, and TNM stageⅡandⅢwere lower (P < 0.05), while the use of neoadjuvant chemotherapy was more common (P < 0.05), the distance of the tumor lower margin from the anal verge was shorter (P < 0.05) in the laparoscopic group.②No differences were seen in terms of anastomotic leakage, pulmonary infection, urinary retention, intestinal obstruction, wound infection, abdominal sepsis, urinary tract infection, stoma complications, poor incision healing, bleeding, intestinal hemorrhage, and deep vein thrombosis between the two groups (P > 0.05). Conclusions The development of postoperative complications in the laparoscopic group is similar to the open group, which are both available approach to the treatment of rectal cancer. But more randomized clinical trials are warranted to confirm which one is better.

Citation： QINHua-bo, XIEMing-hao, LIANLei, HEXiao-sheng, WUXiao-jian, LANPing, WANGJian-ping. Radical Resection of Rectal Cancer: Comparison of Postoperative Complications Following Laparoscopic and Open Surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(5): 530-534. doi: 10.7507/1007-9424.20150142 Copy

1.	Trastulli S, Cirocchi R, Listorti C, et al. Laparoscopic vs open resection for rectal cancer:a meta-analysis of randomized clinical trials. Colorectal Dis, 2012, 14(6):E277-E296.
2.	Tanis PJ, Buskens CJ, Bemelman WA. Laparoscopy for colorectal cancer. Best Pract Res Clin Gastroenterol, 2014, 28(1):29-39.
3.	Hui VW, Guillem JG. Minimal access surgery for rectal cancer:an update. Nat Rev Gastroenterol Hepatol, 2014, 11(3):158-165.
4.	Mizrahi I, Mazeh H. Role of laparoscopy in rectal cancer:a review. World J Gastroenterol, 2014, 20(17):4900-4907.
5.	Yamamoto M, Okuda J, Tanaka K, et al. Effect of previous abdominal surgery on outcomes following laparoscopic colorectal surgery. Dis Colon Rectum, 2013, 56(3):336-342.
6.	孙亚锋, 池畔.既往腹部手术史对腹腔镜辅助直肠癌根治术患者近期疗效的影响.中华胃肠外科杂志, 2014, 17(8):791-795.
7.	张涌泉, 丛风云, 许景洪, 等.腹腔镜下超低位直肠癌根治术可行性分析.医学临床研究, 2014, 31(6):1138-1139.
8.	Zeng WG, Zhou ZX, Liang JW, et al. Impact of interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer on surgical and oncologic outcome. J Surg Oncol, 2014, 110(4):463-467.
9.	Ahn DH, Wu C, Wei L, et al. The efficacy of adjuvant chemotherapy in patients with stageⅡ/Ⅲresected rectal cancer treated with neoadjuvant chemoradiation therapy. Am J Clin Oncol, 2015 Feb 25.[Epub ahead of print].
10.	Wu WX, Sun YM, Hua YB, et al. Laparoscopic versus conventional open resection of rectal carcinoma:A clinical comparative study. World J Gastroenterol, 2004, 10(8):1167-1170.
11.	Zhao JK, Chen NZ, Zheng JB, et al. Laparoscopic versus open surgery for rectal cancer:Results of a systematic review and metaanalysis on clinical efficacy. Mol Clin Oncol, 2014, 2(6):1097-1102.
12.	孙延东, 吴国豪, 张波, 等.腹腔镜与开腹手术治疗直肠癌的临床对照研究.中华胃肠外科杂志, 2014, 17(4):369-372.
13.	Gonzalez QH, Rodriguez-Zentner H, Moreno-Berber JM, et al. Laparoscopic vs. open total mesorectal excision for treatment of rectal cancer. Rev Invest Clin, 2008, 60(3):205-211.
14.	Law WL, Lee YM, Choi HK, et al. Laparoscopic and open anterior resection for upper and mid rectal cancer:an evaluation of outcomes. Dis Colon Rectum, 2006, 49(8):1108-1115.
15.	Xiong BH, Ma L, Zhang CQ. Laparoscopic versus open total mesorectal excision for middle and low rectal cancer:a meta-analysis of results of randomized controlled trials. J Laparoendosc Adv Surg Tech A, 2012, 22(7):674-684.
16.	Staudacher C, Vignali A, Saverio DP, et al. Laparoscopic vs. open total mesorectal excision in unselected patients with rectal cancer:impact on early outcome. Dis Colon Rectum, 2007, 50(9):1324-1331.
17.	Choi HK, Law WL, Ho JW. Leakage after resection and intraperitoneal anastomosis for colorectal malignancy:Analysis of risk factors. Dis Colon Rectum, 2006, 49(11):1719-1725.
18.	Eberl T, Jagoditsch M, Klingler AA. Risk factors for anastomotic leakage after resection for rectal cancer. Am J Surg, 2008, 196(4):592-598.
19.	Leichtle SW, Mouawad NJ, Welch KB, et al. Risk factors for anastomotic leakage after colectomy. Dis Colon Rectum, 2012, 55(5):569-575.
20.	Krarup PM, Jorgensen LN, Andreasen AH, et al. A nationwide study on anastomotic leakage after colonic cancer surgery. Colorectal Dis, 2012, 14(10):E661-E667.
21.	Lujan J, Valero G, Biondo S, et al. Laparoscopic versus open surgery for rectal cancer:results of a prospective multicentre analysis of 4 970 patients. Surg Endosc, 2013, 27(1):295-302.
22.	董功航, 汪建平, 邓艳红, 等.术前经新辅助治疗的中低位直肠癌患者吻合口漏的预防和治疗.中华普通外科杂志, 2009, 24(2):100-102.
23.	Zheng MH, Feng B, Hu CY, et al. Long-term outcome of laparoscopic total mesorectal excision for middle and low rectal cancer. Minim Invasive Ther Allied Technol, 2010, 19(6):329-339.
24.	赵沨, 施培友.直肠癌TME术中保留盆腔自主神经对男性性功能及排尿功能的影响.中国普外基础与临床杂志, 2011, 18(2):191-195.
25.	顾晋, 马朝来, 夏家骝.直肠癌根治术中保留骨盆自主神经的神经解剖学基础及临床意义.中华外科杂志, 2000, 38(2):128-130.
26.	许钊荣, 池畔.腹腔镜与开腹结直肠癌根治术后并发症发生率的比较.中华胃肠外科杂志, 2012, 15(8):810-813.
27.	Van Der Pas MH, Haglind E, Cuesta MA, et al. Laparoscopic versus open surgery for rectal cancer (COLORⅡ):short-term outcomes of a randomised, phase 3 trial. Lancet Oncol, 2013, 14(3):210-218.
28.	陈伟鑫, 俞鑫苗, 张建海.术后早期炎症性肠梗阻的影响因素.中国现代医生, 2012, 50(13):28-29, 32.
29.	Ying XJ, Li ZJ, Shen Y, et al. Total mesorectal excision for rectal cancer:laparoscopic versus open approach. Tumori, 2013, 99(2):154-158.

1. Trastulli S, Cirocchi R, Listorti C, et al. Laparoscopic vs open resection for rectal cancer:a meta-analysis of randomized clinical trials. Colorectal Dis, 2012, 14(6):E277-E296.
2. Tanis PJ, Buskens CJ, Bemelman WA. Laparoscopy for colorectal cancer. Best Pract Res Clin Gastroenterol, 2014, 28(1):29-39.
3. Hui VW, Guillem JG. Minimal access surgery for rectal cancer:an update. Nat Rev Gastroenterol Hepatol, 2014, 11(3):158-165.
4. Mizrahi I, Mazeh H. Role of laparoscopy in rectal cancer:a review. World J Gastroenterol, 2014, 20(17):4900-4907.
5. Yamamoto M, Okuda J, Tanaka K, et al. Effect of previous abdominal surgery on outcomes following laparoscopic colorectal surgery. Dis Colon Rectum, 2013, 56(3):336-342.
6. 孙亚锋, 池畔.既往腹部手术史对腹腔镜辅助直肠癌根治术患者近期疗效的影响.中华胃肠外科杂志, 2014, 17(8):791-795.
7. 张涌泉, 丛风云, 许景洪, 等.腹腔镜下超低位直肠癌根治术可行性分析.医学临床研究, 2014, 31(6):1138-1139.
8. Zeng WG, Zhou ZX, Liang JW, et al. Impact of interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer on surgical and oncologic outcome. J Surg Oncol, 2014, 110(4):463-467.
9. Ahn DH, Wu C, Wei L, et al. The efficacy of adjuvant chemotherapy in patients with stageⅡ/Ⅲresected rectal cancer treated with neoadjuvant chemoradiation therapy. Am J Clin Oncol, 2015 Feb 25.[Epub ahead of print].
10. Wu WX, Sun YM, Hua YB, et al. Laparoscopic versus conventional open resection of rectal carcinoma:A clinical comparative study. World J Gastroenterol, 2004, 10(8):1167-1170.
11. Zhao JK, Chen NZ, Zheng JB, et al. Laparoscopic versus open surgery for rectal cancer:Results of a systematic review and metaanalysis on clinical efficacy. Mol Clin Oncol, 2014, 2(6):1097-1102.
12. 孙延东, 吴国豪, 张波, 等.腹腔镜与开腹手术治疗直肠癌的临床对照研究.中华胃肠外科杂志, 2014, 17(4):369-372.
13. Gonzalez QH, Rodriguez-Zentner H, Moreno-Berber JM, et al. Laparoscopic vs. open total mesorectal excision for treatment of rectal cancer. Rev Invest Clin, 2008, 60(3):205-211.
14. Law WL, Lee YM, Choi HK, et al. Laparoscopic and open anterior resection for upper and mid rectal cancer:an evaluation of outcomes. Dis Colon Rectum, 2006, 49(8):1108-1115.
15. Xiong BH, Ma L, Zhang CQ. Laparoscopic versus open total mesorectal excision for middle and low rectal cancer:a meta-analysis of results of randomized controlled trials. J Laparoendosc Adv Surg Tech A, 2012, 22(7):674-684.
16. Staudacher C, Vignali A, Saverio DP, et al. Laparoscopic vs. open total mesorectal excision in unselected patients with rectal cancer:impact on early outcome. Dis Colon Rectum, 2007, 50(9):1324-1331.
17. Choi HK, Law WL, Ho JW. Leakage after resection and intraperitoneal anastomosis for colorectal malignancy:Analysis of risk factors. Dis Colon Rectum, 2006, 49(11):1719-1725.
18. Eberl T, Jagoditsch M, Klingler AA. Risk factors for anastomotic leakage after resection for rectal cancer. Am J Surg, 2008, 196(4):592-598.
19. Leichtle SW, Mouawad NJ, Welch KB, et al. Risk factors for anastomotic leakage after colectomy. Dis Colon Rectum, 2012, 55(5):569-575.
20. Krarup PM, Jorgensen LN, Andreasen AH, et al. A nationwide study on anastomotic leakage after colonic cancer surgery. Colorectal Dis, 2012, 14(10):E661-E667.
21. Lujan J, Valero G, Biondo S, et al. Laparoscopic versus open surgery for rectal cancer:results of a prospective multicentre analysis of 4 970 patients. Surg Endosc, 2013, 27(1):295-302.
22. 董功航, 汪建平, 邓艳红, 等.术前经新辅助治疗的中低位直肠癌患者吻合口漏的预防和治疗.中华普通外科杂志, 2009, 24(2):100-102.
23. Zheng MH, Feng B, Hu CY, et al. Long-term outcome of laparoscopic total mesorectal excision for middle and low rectal cancer. Minim Invasive Ther Allied Technol, 2010, 19(6):329-339.
24. 赵沨, 施培友.直肠癌TME术中保留盆腔自主神经对男性性功能及排尿功能的影响.中国普外基础与临床杂志, 2011, 18(2):191-195.
25. 顾晋, 马朝来, 夏家骝.直肠癌根治术中保留骨盆自主神经的神经解剖学基础及临床意义.中华外科杂志, 2000, 38(2):128-130.
26. 许钊荣, 池畔.腹腔镜与开腹结直肠癌根治术后并发症发生率的比较.中华胃肠外科杂志, 2012, 15(8):810-813.
27. Van Der Pas MH, Haglind E, Cuesta MA, et al. Laparoscopic versus open surgery for rectal cancer (COLORⅡ):short-term outcomes of a randomised, phase 3 trial. Lancet Oncol, 2013, 14(3):210-218.
28. 陈伟鑫, 俞鑫苗, 张建海.术后早期炎症性肠梗阻的影响因素.中国现代医生, 2012, 50(13):28-29, 32.
29. Ying XJ, Li ZJ, Shen Y, et al. Total mesorectal excision for rectal cancer:laparoscopic versus open approach. Tumori, 2013, 99(2):154-158.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Radical Resection of Rectal Cancer: Comparison of Postoperative Complications Following Laparoscopic and Open Surgery

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