A propensity‐score‐matched analysis of laparoscopic vs open surgery for rectal cancer in a population‐based study

Abstract

Aim The oncological risk/benefit trade‐off for laparoscopy in rectal cancer is controversial. Our aim was to compare laparoscopic vs open surgery for resection of rectal cancer, using unselected data from the public healthcare system of Catalonia (Spain). Methods This was a multicentre retrospective cohort study of all patients who had surgery with curative intent for primary rectal cancer at Catalonian public hospitals from 2011 to 2012. We obtained follow‐up data for up to 5 years. To minimize the differences between the two groups, we performed propensity score matching on baseline patient characteristics. We used multivariate Cox proportional hazards regression analyses to assess locoregional relapse at 2 years and death at 2 and 5 years. Results Of 1513 patients with Stage I–III rectal cancer, 933 (61.7%) had laparoscopy (conversion rate 13.2%). After applying our propensity score matching strategy (2:1), 842 laparoscopy patients were matched to 517 open surgery patients. Multivariate Cox analysis of death at 2 years [hazard ratio (HR) 0.65, 95% CI 0.48, 0.87; P = 0.004] and 5 years (HR 0.61, 95% CI 0.5, 0.75; P < 0.001) and of local relapse at 2 years (HR 0.44, 95% CI 0.27, 0.72; P = 0.001) showed laparoscopy to be an independent protective factor compared with open surgery. Conclusions Laparoscopy results in lower locoregional relapse and long‐term mortality in rectal cancer in unselected patients with all‐risk groups included. Studies using long‐term follow‐up of cohorts and unselected data can provide information on clinically relevant outcomes to supplement randomized controlled trials.

Long term oncological outcomes for laparoscopic versus open surgery for rectal cancer – A population‐based nationwide noninferiority study

“…Draeger et al [31] compared LAP and OPEN in a regional German registry‐based cohort comprising more than 1500 rectal cancer patients operated on from 2004 to 2013, and found that overall survival and cancer‐specific survival was higher in the LAP group. In a registry‐based study from Spain, Manchon‐Walsh et al [32] also compared more than 1500 rectal cancer patients undergoing LAP or OPEN surgery during 2011–2012 using propensity score matching, and found that LAP patients had better overall and cancer‐specific survival as well as fewer local recurrences.…”

The impact of robotic total mesorectal excision on survival of patients with rectal cancer—a propensity matched analysis

“…A recent propensity-matched analysis including T4 tumours showed a 2-year DFS of 64.9% for stage III patients in the laparoscopic group. [6] Oncological outcomes of randomized control trials comparing R-TME vs. L-TME have not been published yet. However, previous descriptive studies showed equivalence in terms on DFS and OS.…”

Prognostic implications of surgical specimen quality on the oncological outcomes of open and laparoscopic surgery in mid and low rectal cancer

“…In COLOR II trial, patients with stage III operated laparoscopically showed better rate of DFS than the open surgery group with a difference of 12.9% [ 6 ]. A recent Spanish population-based study comparing laparoscopic with open surgery that included 1359 patients showed that laparoscopy was an independent factor for better LR and long-term OS rates in rectal cancer [ 21 ]. Other published population-based studies with long-term follow-up reported that the laparoscopic approach had better oncological outcomes than the open surgery [ 22 , 23 ].…”