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Long term oncological outcomes for laparoscopic versus open surgery for rectal cancer: a population based nationwide non-inferiority study
Örebro University, School of Medical Sciences. Department of Surgery, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0002-6671-7130
Örebro University, School of Medical Sciences. Örebro University Hospital. (Clinical Epidemiology and Biostatistics)ORCID iD: 0000-0002-3552-9153
Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Surgery, SSORG - Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
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2022 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 24, no 11, p. 1308-1317Article in journal (Refereed) Published
Abstract [en]

AIM: The aim was to compare five-year overall survival in a national cohort of patients undergoing curative abdominal resection for rectal cancer by laparoscopic (LAP) or open (OPEN) technique.

METHODS: All patients diagnosed with clinical stage I-III rectal cancer and who underwent LAP or OPEN abdominal curative surgery between 2010 and 2016 in Sweden were retrieved from the Swedish Colorectal Cancer Registry. A non-inferiority study design was employed with a statistical power of 90%, a one-side type I error of 2.5%, and a non-inferiority margin of 2%. The analyses were performed as intention-to-treat and the relationship between surgical technique and overall mortality within five years was analyzed. Multilevel regression models with the patients matched by propensity scores adjusted for patient and tumour related variables.

RESULTS: A total of 8410 cancer stage I-III patients were included whereof 2094 LAP (24.9%) and 6316 underwent OPEN (74.9%) and were followed until December 31, 2020. Multivariable Cox regression demonstrated that five-year overall survival was higher in LAP; Hazard Ratio (HR): 0.877;(95% CI: 0.877-0.993). Outcome was similar when employing multiple imputation and propensity score matching. When excluding cT4 there was no difference; HR: 0.885;(95% CI: 0.790-1.033). At five years follow up, local recurrence was not different, 2.9% in LAP and 3.6% in OPEN (P=0.075), while metastatic disease was more frequent in OPEN, 19.6% compared with 15.6% in LAP (P<0.001).

CONCLUSIONS: This study demonstrated that LAP was not inferior to OPEN with regard to overall five-year survival. These results support the use of laparoscopic surgery.

Place, publisher, year, edition, pages
Blackwell Publishing, 2022. Vol. 24, no 11, p. 1308-1317
Keywords [en]
Rectal cancer, laparoscopy, minimally invasive surgery, multiple imputation, non-inferiority, oncological outcome, population based, propensity score, survival
National Category
Cancer and Oncology Surgery
Identifiers
URN: urn:nbn:se:oru:diva-99524DOI: 10.1111/codi.16204ISI: 000822846800001PubMedID: 35656573Scopus ID: 2-s2.0-85133674068OAI: oai:DiVA.org:oru-99524DiVA, id: diva2:1670269
Note

Funding agency:

Research Committee, Region Örebro County, Örebro OLL-964736

Available from: 2022-06-15 Created: 2022-06-15 Last updated: 2024-01-12Bibliographically approved
In thesis
1. Long-term outcome, socioeconomic aspects and postoperative inflammatory response in minimally invasive rectal cancer surgery
Open this publication in new window or tab >>Long-term outcome, socioeconomic aspects and postoperative inflammatory response in minimally invasive rectal cancer surgery
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In Sweden, more than 2,200 individuals are diagnosed with rectal cancer each year and surgical resection is the cornerstone of treatment. Minimally invasive surgery (MIS) was introduced for abdominal rectal cancer resection in the 1990s. Proven advantages of MIS in the short term include less intraoperative bleeding, less postoperative pain, faster postoperative mobilization, and shorter hospital stay. Large randomized studies have also shown that MIS is not inferior to OPEN with regard to the oncological short-term or long-term outcome.

The aim of this thesis was to increase the knowledge of MIS from a Swedish perspective regarding long-term oncological outcome, socioeconomic aspects, and the postoperative inflammatory response in curative abdominal rectal cancer surgery.

Study I included all patients who were diagnosed with clinical stage I-III rectal cancer during 2010-2016. More than 8,300 patients were identified via the Swedish Colorectal Cancer Registry (SCRCR). The study had a so-called non-inferiority design and investigated overall 5-year survival. The results showed that survival was not worse in patients who underwent minimally invasive surgery in comparison to patients who underwent open surgery.

Study II included all patients who were diagnosed with pathological stage I-III cancer of the colon 2010-2016. More than 11,000 patients were identified via the SCRCR. The study was designed in the same way as Study I. The results demonstrated that minimally invasive surgery was not inferior to open surgery.

Study III analysed the potential impact of socioeconomic status, measured as level of education and household income, regarding the likelihood of receiving minimally invasive surgery. All patients who underwent curative abdominal rectal resection surgery during 2010-2016 were included. More than 8,000 patients were identified. The results showed that patients with the highest level of education and those in the highest income quartile were more likely to be operated on with minimally invasive technique.

Study IV analysed the inflammatory response, measured as serum C-reactive protein during postoperative days 1-5, in all 520 patients undergoing abdominal rectal resection in Örebro between 2011 and 2021. Following exclusions based on postoperative adverse events, 382 patients remained for final analysis. The study demonstrated a trend for a less pronounced inflammatory response in patients operated with robot-assisted laparoscopy compared with conventional laparoscopy.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2024. p. 70
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 286
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-110084 (URN)9789175295343 (ISBN)
Public defence
2024-02-02, Örebro universitet, Campus USÖ, X2502 (Tidefeltsalen), Södra Grev Rosengatan 32, Örebro, 09:00 (English)
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Available from: 2023-12-07 Created: 2023-12-07 Last updated: 2024-02-16Bibliographically approved

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Dehlaghi Jadid, KavehCao, YangMatthiessen, Peter

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