Better Survival after Hand-Assisted Laparoscopic Surgery than Conventional Laparotomy for Rectal Cancer: Five-Year Results from a Single Center in Japan

Takayuki Tajima, Masaya Mukai, Takuya Koike, Daiki Yokoyama, Shyuji Uda, Hisamichi Yoshii, Shigeo Higami, Hideki Izumi, Sayuri Hasegawa, Eiji Nomura and Hiroyasu Makuuchi

Department of Surgery, Tokai University Oiso Hospital, Japan
Department of Surgery, Tokai University Hachioji Hospital, Japan

^*Correspondance to: Masaya Mukai 

 PDF  Full Text DOI: 10.25107/2474-1647.1368

Abstract

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.

Keywords

Hand-assisted laparoscopic surgery; Conventional laparotomy; Laparoscopyassisted colorectal surgery; Colorectal cancer; Rectal cancer; Minimally invasive surgery

Cite the article

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.