Abstract
Aim: The goal of this registry study was to compare open surgery with planned laparoscopy and then with laparoscopic–to-open conversion for rectal cancer surgery.
Method: The study included 17964 rectal cancer patients, operated between Jan 1, 2000–Dec 31, 2009, from 345 hospitals in Germany. All statistical tests were two-sided, with chi-square test (Pearson correlation) for patients and tumour characteristics. Fisher’s exact test was used for complications and 30 day mortality.
Results: Of the 17964 rectal cancer patients, 16308 (90.8%) had an open procedure and 1656 (9.2%) were started with a laparoscopy. The 1455 patients with completed laparoscopic operations had fewer intra- and postoperative complications (5.4% vs. 7.0%, p=0.020 and 20.5% vs. 25.8%, p<0.001, respectively) and a lower 30 day mortality rate (1.1% vs. 1.9%, p=0.023). Of the 1656 planned laparoscopies, 201(12.1%) were converted to open. The converted group suffered more intraoperative complications (18.9% vs. 3.6% for completed laparoscopy and 7.0% for open surgery, p<0.0001) and postoperative complications (32.3% vs. 18.9% for completed laparoscopies and 25.8% for open operations, [p<0.0001]). The converted group also had a higher 30 day mortality rate (2.0% vs. 1.0% for completed laparoscopies and 1.9% for open surgery, p=0.043).
Conclusion: The more favourable patient profile provided justification for a laparoscopic procedure. For those converted to an open procedure, however, there were significantly more complications than planned open surgery patients. A move away from the standard open procedure for rectal cancer surgery and towards laparoscopy is not yet feasible.
© 2012 The Authors Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland
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