Does oncological outcome differ between restorative and nonrestorative low anterior resection in patients with primary rectal cancer?. (15th December 2020)

• Record Type: Journal Article
• Authors: Roodbeen, Sapho X.; Blok, Robin D.; Borstlap, Wernard A.; Bemelman, Willem A.; Hompes, Roel; Tanis, Pieter J.
• Other Names: Aalbers AGJ investigator.; Acherman Y investigator.; Algie GD investigator.; Alting von Geusau B investigator.; Amelung F investigator.; Aukema TS investigator.; Bakker IS investigator.; Bartels SA investigator.; Basha S investigator.; Bastiaansen AJNM investigator.; Belgers E investigator.; Bleeker W investigator.; Blok J investigator.; Bosker RJI investigator.; Bosmans JW investigator.; Boute MC investigator.; Bouvy ND investigator.; Bouwman H investigator.; Brandt‐Kerkhof A investigator.; Brinkman DJ investigator.; Bruin S investigator.; Bruns ERJ investigator.; Burbach JPM investigator.; Burger JWA investigator.; Buskens CJ investigator.; Clermonts S investigator.; Coene PPLO investigator.; Compaan C investigator.; Consten ECJ investigator.; Darbyshire T investigator.; de Mik SML investigator.; de Graaf EJR investigator.; de Groot I investigator.; de Vos tot Nederveen Cappel RJ investigator.; de Wilt JHW investigator.; van der Wolde J investigator.; den Boer FC investigator.; Dekker JWT investigator.; Demirkiran A investigator.; Derkx‐Hendriksen M investigator.; Dijkstra FR investigator.; van Duijvendijk P investigator.; Dunker MS investigator.; Eijsbouts QE investigator.; Fabry H investigator.; Ferenschild F investigator.; Foppen JW investigator.; Furnee EJB investigator.; Gerhards MF investigator.; van Gerven P investigator.; Gooszen JAH investigator.; Govaert JA investigator.; Van Grevenstein WMU investigator.; Haen R investigator.; Harlaar JJ investigator.; van der Harst E investigator.; Havenga K investigator.; Heemskerk J investigator.; Heeren JF investigator.; Heijnen B investigator.; Heres P investigator.; Hoff C investigator.; Hogendoorn W investigator.; Hoogland P investigator.; Huijbers A investigator.; Janssen P investigator.; Jongen AC investigator.; Jonker FH investigator.; Karthaus EG investigator.; Keijzer A investigator.; Ketel JMA investigator.; Klaase J investigator.; Kloppenberg FWH investigator.; Kool ME investigator.; Kortekaas R investigator.; Kruyt PM investigator.; Kuiper JT investigator.; Lamme B investigator.; Lange JF investigator.; Lettinga T investigator.; Lips DJ investigator.; Logeman F investigator.; Lutke Holzik MF investigator.; Madsen E investigator.; Mamound A investigator.; Marres CC investigator.; Masselink I investigator.; Meerdink M investigator.; Menon AG investigator.; Mieog JS investigator.; Mierlo D investigator.; Musters GD investigator.; Nieuwenhuijzen GAP investigator.; Neijenhuis PA investigator.; Nonner J investigator.; Oostdijk M investigator.; Oosterling SJ investigator.; Paul PMP investigator.; Peeters KCMJ investigator.; Pereboom ITA investigator.; Polat F investigator.; Poortman P investigator.; Raber M investigator.; Reiber BMM investigator.; Renger RJ investigator.; van Rossem CC investigator.; Rutten HJ investigator.; Rutten A investigator.; Schaapman R investigator.; Scheer M investigator.; Schoonderwoerd L investigator.; Schouten N investigator.; Schreuder AM investigator.; Schreurs WH investigator.; Simkens GA investigator.; Slooter GD investigator.; Sluijmer HCE investigator.; Smakman N investigator.; Smeenk R investigator.; Snijders HS investigator.; Sonneveld DJA investigator.; Spaansen B investigator.; Spillenaar Bilgen EJ investigator.; Steller E investigator.; Steup WH investigator.; Steur C investigator.; Stortelder E investigator.; Straatman J investigator.; Swank HA investigator.; Sietses C investigator.; Groen HA investigator.; ten Hoeve HG investigator.; ter Riele WW investigator.; Thorensen IM investigator.; Tip‐Pluijm B investigator.; Toorenvliet BR investigator.; Tseng L investigator.; Tuynman JB investigator.; van Bastelaar J investigator.; van Beek SC investigator.; van de Ven AWH investigator.; van de Weijer MAJ investigator.; van den Berg C investigator.; van den Bosch I investigator.; van der Bilt JDW investigator.; van der Hagen SJ investigator.; van der Hul R investigator.; van der Schelling G investigator.; van der Spek A investigator.; van der Wielen N investigator.; van Duyn E investigator.; van Eekelen C investigator.; van Essen JA investigator.; van Gangelt K investigator.; van Geloven AAW investigator.; van Kessel C investigator.; van Loon YT investigator.; van Rijswijk A investigator.; van Rooijen SJ investigator.; van Sprundel T investigator.; van Steensel L investigator.; van Tets WF investigator.; van Westreenen HL investigator.; Veltkamp SC investigator.; Verhaak T investigator.; Verheijen PM investigator.; Versluis‐Ossenwaarde L investigator.; Vijfhuize S investigator.; Vles WJ investigator.; Voeten SC investigator.; Vogelaar FJ investigator.; Vrijland WW investigator.; Westerduin E investigator.; Westerterp ME investigator.; Wetzel M. investigator.; Wevers KP investigator.; Wiering B investigator.; Witjes CDM investigator.; Wouters MW investigator.; Yauw STK investigator.; van der Zaag ES investigator.; Zeestraten EC investigator.; Zimmerman DDE investigator.; Zwiete T investigator.;
• Is Part Of: Colorectal disease. Volume 23:Number 4(2021)
• Page Start: 843
• Page End: 852
• Publication Date: 2020-12-15
• Subjects: local recurrence -- oncological outcome -- low anterior resection -- rectal surgery; Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.15464
• Languages: English
• ISSNs: 1462-8910

Abstract

Abstract: Aim: Nonrestorative low anterior resection (n‐rLAR) (also known as low Hartmann's) is performed for rectal cancer when a poor functional outcome is anticipated or there have been problems when constructing the anastomosis. Compared with restorative LAR (rLAR), little oncological outcome data are available for n‐rLAR. The aim of this study was to compare oncological outcomes between rLAR and n‐rLAR for primary rectal cancer. Method: This was a nationwide cross‐sectional comparative study including all elective sphincter‐saving LAR procedures for nonmetastatic primary rectal cancer performed in 2011 in 71 Dutch hospitals. Oncological outcomes of patients undergoing rLAR and n‐rLAR were collected in 2015; the data were evaluated using Kaplan–Meier survival analysis and the results compared using log‐rank testing. Uni‐ and multivariable Cox regression analysis was used to evaluate the association between the type of LAR and oncological outcome measures. Results: A total of 1197 patients were analysed, of whom 892 (75%) underwent rLAR and 305 (25%) underwent n‐rLAR. The 3‐year local recurrence (LR) rate was 3% after rLAR and 8% after n‐rLAR ( P < 0.001). The 3‐year disease‐free survival and overall survival rates were 77% (rLAR) vs 62% (n‐rLAR) ( P < 0.001) and 90% (rLAR) vs 75% (n‐rLAR) ( P < 0.001), respectively. In multivariable Cox analysis, n‐rLAR was independently associated with a higher risk of LR (OR = 2.95) and worse overall survival (OR = 1.72). Conclusion: This nationwide study revealed that n‐rLAR for rectal cancer was associated with poorer oncological outcome than r‐LAR. This is probably a noncausal relationship, and might reflect technical difficulties during low pelvic dissection in a subset of those patients, with oncological implications.