Clinical Research Papers:
Longterm outcomes and propensity score matching analysis: rectal cancer resection for patients with elevated preoperative risk
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Hao Feng1,2, Tobias S. Schiergens2, Zhi-hai Mao1, Jingkun Zhao1,2, Xiaohui Shen1, Ai-Guo Lu1 and Wolfgang E. Thasler3
1 Department of Digestive Surgery, Ruijin Hospital, Shanghai Jiao-tong University School of Medicine, Shanghai, China
2 Department of General, Visceral, Transplant, and Vascular Surgery, University Hospital of Ludwig Maximilian University of Munich, Munich, Germany
3 Department of General and Visceral Surgery, Red Cross Hospital of Munich, Munich, Germany
Correspondence to:
Ai-guo Lu, email:
Hao Feng, email:
Keywords: laparoscopy; rectal cancer; operative risk; Cr-POSSUM system; complications
Received: July 20, 2016 Accepted: October 17, 2016 Published: December 09, 2016
Abstract
BACKGROUND: It is still controversial about the treatment strategy for rectal cancer patients with elevated operative risk and elder rectal cancer patients.
METHODS: This study presented a retrospective single center experience in rectal cancer proctectomy for high operative risk patients. High operative risk patient was defined as Cr-POSSUM > 5% combined with associated risk factors. 220 in 1477 consecutive patients met the inclusion criteria.
RESULTS: 132 patients were selected (66:66) after propensity score matching. The total complication rate between conventional open rectal resection (71 %) and laparoscopic surgery (41%) was significantly different (p = 0.0005). There is a significantly positive correlation between open surgery and advanced Dindo Classification (p = 0.02). Cr-POSSUM is positively correlated with Dindo Classification (p = 0.01). There was no significant difference in survival rate among stage I~II, different age groups or different Cr-POSSUM score sub-groups. However, stage III-IV tumor patients in laparoscopic group experienced improved overall survival rate. (p < 0.0001). For patients with preoperative pulmonary or renal disease, patients in laparoscopic group also had better long term prognosis (p = 0.03, p = 0.049).
CONCLUSIONS: The results demonstrate the potential advantages of laparoscopic rectal cancer resection for high operative risk patients, especially for the patients with preoperative respiratory or renal disease and stage III cancer.