SAFETY OF LAPAROSCOPIC RECTAL CANCER SURGERY 

NEW YORK (Reuters Health) May 01 - A study comparing laparoscopic to open surgery for rectal cancer has confirmed the long-term oncologic safety of the laparoscopic approach.

"This pooled analysis of three randomized controlled trials with a follow-up of more than 10 years demonstrates that laparoscopic surgery for rectal cancer is associated with similar long-term recurrence and survival rates when compared with open surgery," the researchers conclude.

Starting in 1993, Dr. Simon S. M. Ng and colleagues at Prince of Wales Hospital and the Chinese University of Hong Kong, conducted three randomized trials comparing open surgery to various laparoscopic approaches in resecting upper, mid and lower rectal cancers.

Although the results were consistent, firm conclusions on long-term outcomes could not be determined because of the relatively small sample sizes. The team therefore pooled the data, covering 278 patients who underwent curative resection -- 136 having laparoscopic procedures and 142 open surgeries -- for the current study.

Median follow-up for living patients in the two groups was 124.5 and 136.6 months, respectively. There were no significant differences in outcomes, the authors reported in the Annals of Surgery online April 23.

At 10 years, locoregional recurrence rates were 5.5% versus 9.3% (p=0.296) in the laparoscopic and open groups, respectively. Corresponding rates of cancer-specific survival were 82.5% versus 77.6% (p=0.443) and overall survival was 63.0% versus 61.1% (p=0.505).

In fact, Dr. Ng mentioned in an email to Reuters Health, "There was a trend towards lower cancer recurrence rate at 10 years in the laparoscopic group when compared with the open group among patients with stage III rectal cancer (p=0.078)."

The study was also designed to look at predictors of survival, and it identified three already known risk factors for poorer cancer-specific survival: namely, stage III cancer, lymphovascular permeation, and postoperative blood transfusion. Operative method was not a predictor of survival.

Dr. Ng and colleagues note that resection margins and the number of lymph nodes removed were similar in the laparoscopic and open groups. In particular, the rate of resection margin involvement was low at 1.5% in the laparoscopic group and 1.4% in the open surgery group. They attribute this to standardized techniques used by experienced surgeons at their center.

"Based on our own results and those from other published RCTs, we believe that laparoscopic proctectomy can now be regarded as an acceptable alternative to open surgery for curable rectal cancer" Dr. Ng concluded. "Forthcoming phase III multicenter RCTs, including the American College of Surgeons Oncology Group Z6051 trial and the long-term data of the COREAN trial and the COLOR II trial, will more definitely evaluate whether laparoscopic surgery will emerge as the standard of care for patients with rectal cancer in the future."

The current results will feed into a review of current guidelines, Dr. Ng added. "The ASCRS and SAGES joint position statement on laparoscopic proctectomy for curable rectal cancer was issued in 2005 and has not been revised since then. Both societies are waiting for further evidence to support or refute the use of laparoscopy for treating rectal cancer. Our studies have indeed contributed to the growing body of data supporting the short-term benefits of laparoscopic surgery for rectal cancer and its long-term oncologic equivalence to open surgery, and may help revise the position statement."

SOURCE: http://bit.ly/16o9OIZ

Ann Surg 2013.