Influence of Tumor Location on Short- and Long-Term Outcomes After Laparoscopic Surgery for Rectal Cancer: A Propensity Score Matched Cohort Study

Abstract

Background: This study aimed to evaluate the short- and long-term outcomes after laparoscopic resection for low rectal cancer (LRC) compared with mid/high rectal cancer (M/HRC). Methods: Patients with rectal cancer undergoing laparoscopic resection with curative intent were retrospectively reviewed between 2009 and 2015. After matched 1:1 by using propensity score analysis, perioperative and oncological outcomes were compared between LRC and M/HRC groups. Multivariate analysis was performed to identify independent factors of overall survival (OS) and disease-free survival (DFS). Results: Of 373 patients who met the criteria for inclusion, 198 patients were matched for the analysis. Laparoscopic surgery for LRC required longer operative time (P＜0.001) and more blood loss volume (P=0.015) compared with M/HRC, and the LRC group tended to have a higher incidence of postoperative complications (16.2% vs. 8.1%, P=0.082). There was no significant difference in local recurrence between the two groups (9.1% vs. 4.0%, P=0.251), whereas distant metastasis was inclined to be more frequent in LRC patients compared with M/HRC (21.2% vs. 12.1%, P=0.086). The LRC group showed significantly inferior 5-year OS (77.0% vs. 86.4%, P=0.033) and DFS (71.2% vs. 86.2%, P=0.017) compared with the M/HRC group. Multivariate analysis indicated that tumor location was an independent predictor of DFS (HR=2.305, 95% CI 1.203-4.417, P=0.012). Conclusion: Tumor location of the rectal cancer significantly affected the clinical and oncological outcomes after laparoscopic surgery, and it was an independent predictor of DFS.