Takayuki Tajima1, Masaya Mukai2*, Takuya Koike2, Daiki Yokoyama2, Shyuji Uda2, Hisamichi Yoshii2, Shigeo Higami2, Hideki Izumi2, Sayuri Hasegawa2, Eiji Nomura2 and Hiroyasu Makuuchi2
1Department of Surgery, Tokai University Oiso Hospital, Japan
2Department of Surgery, Tokai University Hachioji Hospital, Japan
We previously reported an interim analysis of short-term outcomes and 3-year relapse-free survival (RFS) and overall survival (OS) in 111 patients with stage I-III primary rectal cancer who underwent radical curative resection by hand-assisted laparoscopic surgery (HALS; n=57) or conventional laparotomy (CL; n=54). This time, we report the 5-year postoperative RFS and OS for these patients, as well as the pattern of recurrence. Follow-up for 5 years after surgery was possible in 95.5% of all patients (94.7% after HALS and 96.3% after CL, p=N.S.). With regard to background factors, there were no differences between the HALS group and CL group with respect to gender, age, rectal location, resection method, pathological stage, and treatment including postoperative adjuvant therapy. The 5-year relapse-free survival rate (5Y-RFS) was 82.5% in the HALS group versus 67.7% in the CL group (p=0.084) and the 5-year overall survival rate (5Y-OS) was 92.9% in the HALS group versus 73.7% in the CL group (p=0.005). Recurrence was due to liver metastasis (HALS: 7.0%, n=4; CL: 7.4%, n=4) (p=1.000), lung metastasis (HALS: 3.5%, n=2; CL: 9.3%, n=5) (p=0.263), or local intrapelvic recurrence (HALS: 5.3%, n=3; CL 3.7%, n=2) (p=1.000). No patient was converted from HALS to CL. Based on these results, HALS is associated with better survival of rectal cancer patients than CL.HALS allows safe and reliable minimally invasive surgery at a lower cost than pure laparoscopy, suggesting that 3-port HALS with a small (50 mm) abdominal incision can become a standard operative method.
Hand-assisted laparoscopic surgery; Conventional laparotomy; Laparoscopyassisted colorectal surgery; Colorectal cancer; Rectal cancer; Minimally invasive surgery
Tajima T, Mukai M, Koike T, Yokoyama D, Uda S, Yoshii H, et al. Better Survival after Hand-Assisted Laparoscopic Surgery than Conventional Laparotomy for Rectal Cancer: Five-Year Results from a Single Center in Japan. Clin Surg. 2017; 2: 1368.