A Comparison of Laparoscopic and Open Surgery Following Pre-operative Chemoradiation Therapy for Locally Advanced Lower Rectal Cancer

作者：Kusano Toru; Inomata Masafumi^*; Hiratsuka Takahiro; Akagi Tomonori; Ueda Yoshitake; Tojigamori Manabu; Shiroshita Hidefumi; Etoh Tsuyoshi; Shiraishi Norio; Kitano Seigo

来源：Japanese Journal of Clinical Oncology, 2014, 44(4): 305-310.

DOI：10.1093/jjco/hyu013

• rectal cancer
• chemoradiation therapy
• laparoscopic surgery

Objective: Although pre-operative chemoradiation therapy for advanced lower rectal cancer is a controversial treatment modality, it is increasingly used in combination with surgery. Few studies have considered the combination of chemoradiation therapy followed by laparoscopic surgery for locally advanced lower rectal cancer; therefore, this study aimed to assess the usefulness of this therapeutic combination.
Methods: We retrospectively reviewed the medical records of patients with locally advanced lower rectal cancer treated by pre-operative chemoradiation therapy and surgery from February 2002 to November 2012 at Oita University. We divided patients into an open surgery group and a laparoscopic surgery group and evaluated various parameters by univariate and multivariate analyses.
Results: In total, 33 patients were enrolled (open surgery group, n = 14; laparoscopic surgery group, n = 19). Univariate analysis revealed that compared with the open surgery group, operative time was significantly longer, whereas intra-operative blood loss and intra-operative blood transfusion requirements were significantly less in the laparoscopic surgery group. There were no significant differences in post-operative complication and recurrence rates between the two groups. According to multivariate analysis, operative time and intra-operative blood loss were significant predictors of outcome in the laparoscopic surgery group.
Conclusions: This study suggests that laparoscopic surgery after chemoradiation therapy for locally advanced lower rectal cancer is a safe procedure. Further prospective investigation of the long-term oncological outcomes of laparoscopic surgery after chemoradiation therapy for locally advanced lower rectal cancer is required to confirm the advantages of laparoscopic surgery over open surgery.

• 出版日期2014-4