Laparoscopic versus open resection for stage II/III rectal cancer in obese patients: A multicenter propensity score‐based analysis of short‐ and long‐term outcomes. Issue 1 (16th July 2022)

• Record Type: Journal Article
• Authors: Akagi, Tomonori; Nakajima, Kentaro; Hirano, Yasumitsu; Abe, Tomoya; Inada, Ryo; Kono, Yohei; Shiroshita, Hidefumi; Ohyama, Tetsuji; Inomata, Masafumi; Yamamoto, Seiichiro; Naitoh, Takeshi; Sakai, Yoshiharu; Watanabe, Masahiko
• Is Part Of: Annals of gastroenterological surgery. Volume 7:Issue 1(2023)
• Page Start: 71
• Page End: 80
• Publication Date: 2022-07-16
• Subjects: laparoscopic surgery -- multicenter -- obese -- propensity score matching -- rectal cancer; Digestive organs -- Surgery -- Periodicals; 617.43
• DOI: 10.1002/ags3.12599
• Languages: English
• ISSNs: 2475-0328

Abstract

Abstract: Aim: Whether a laparoscopic procedure can contribute to the improvement of clinical outcomes in obese patients with stage II/III rectal cancer compared to an open procedure remains unclear. Objective: This study evaluated the technical and oncological safety of laparoscopic surgery versus open surgery in obese patients (body mass index [BMI] ≥25 kg/m 2 ) with rectal cancer. Patients and Methods: Data were collected from patients with pathological stage II/III rectal cancer and analyzed. Operations were performed via laparoscopic or open surgery from 2009 to 2013. A comparative analysis was performed after applying propensity score matching to the two cohorts (laparoscopic group and open group). The primary endpoint was 3‐y relapse‐free survival (RFS). Results: Overall, 524 eligible cases were collected from 51 institutions. Equal numbers of propensity score‐matched patients were included in the laparoscopic (n = 193) group and open (n = 193) group. Although the rate of D3 lymph node dissection did not differ between the laparoscopic group (87.0%) and the open group (88.6%), the median number of harvested lymph nodes was significantly lower in the laparoscopic group versus open group (17.5 vs 21, P = 0.0047). The median postoperative hospital stay was also significantly shorter in the laparoscopic group (14 d) vs the open group (17 d) ( P = 0.0014). Three‐y RFS was not significantly different between the two groups (hazard ratio 1.2454, 95% confidence interval 0.9201–1.6884, P = 0.4689). Conclusion: The short‐ and long‐term results of this large cohort study (UMIN ID: UMIN000033529) indicated that laparoscopic surgery in obese rectal cancer patients has advantageous short‐term outcomes and no disadvantageous long‐term outcomes. Abstract : Kaplan‐Meier plot for relapse‐free survival (RFS) after propensity score (PS) matching.