Long-term safety of open surgery vs. laparoscopic surgery in rectal cancer resection
Researchers confirmed the long-term oncological safety of laparoscopic surgery was comparable to the long-term safety of open surgery in patients with rectal cancer, according to The Lancet Gastroenterology and Hepatology.
“Laparoscopic surgery has the benefits of reduced postoperative pain and faster recovery from surgery than open surgery. However, the status of laparoscopic surgery has not been established yet for rectal cancer,” Ji Won Park, MD, department of surgery at Seoul National University College of Medicine in Seoul, South Korea, and colleagues wrote. “The COREAN trial was an open-label, non-inferiority, randomized trial that compared the safety and efficacy of laparoscopic surgery to that of open surgery for middle or low rectal cancer treated with preoperative chemoradiotherapy. ... Because the time to local recurrence tends to be prolonged after preoperative treatment in rectal cancer, an extended follow-up is required to assess definitive survival outcomes.”
Based on 10-year data from the COREAN trial, researchers analyzed 338 patients with rectal cancer for the long-term outcomes of open surgery (n = 170) vs. laparoscopic surgery (n = 168). After a median follow-up of 143 months, researchers observed no differences between the open surgery group vs. the laparoscopic surgery group in 10-year overall survival (74.1%; 95% CI, 66.8-80 vs. 76.8%; 95% CI, 69.6-82.5), 10-year disease-free survival (59.3%; 95% CI, 51.1-66.5 vs. 64.3%; 95% CI, 56-71.5) or 10-year local recurrence (8.9%; 95% CI, 5.2-15 vs. 3.4%; 95% CI, 1.4-7.9). Stratified hazard ratios were 0.94, 1.05 and 2.22 for overall survival, disease-free survival and local recurrence, respectively. Researchers noted this study identified delayed recurrence (5-years post-surgery) accounted for 10% of all recurrences, 17% of all local recurrences and 8% of all distant recurrences.
“The 10-year follow-up analysis of the COREAN trial showed that laparoscopic surgery for locally advanced rectal cancer after preoperative chemoradiotherapy can provide survival outcomes similar to those of open surgery,” Park and colleagues concluded. “Laparoscopic surgery does not compromise long-term survival outcomes in rectal cancer when performed by well qualified colorectal surgeons.”
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