Objectives: To evaluate the overall survival and disease-free survival of laparoscopic surgery for rectal cancer. Subjects and methods: 107 patients with rectal cancer who underwent laparoscopic surgery, overall survival and disease-free survival after laparoscopic surgery was calculated using the Kaplan-Meier test. Results: The overall survival and disease-free survival of 12, 24 and 36 months were 98.1% and 98.1%; 94.9% and 93.8%; 83.7% and 76.9%, respectively.
Trang 1OVERALL SURVIVAL AND DISEASE-FREE SURVIVAL OF LAPAROSCOPIC SURGERY FOR RECTAL CANCER
Pham Thai Ha 1 ; Nguyen Xuan Hung 2
Nguyen Quoc Dung 3; Nguyen Van Xuyen 4
SUMMARY
Objectives: To evaluate the overall survival and disease-free survival of laparoscopic surgery for rectal cancer Subjects and methods: 107 patients with rectal cancer who underwent laparoscopic surgery, overall survival and disease-free survival after laparoscopic surgery was calculated using the Kaplan-Meier test Results: The overall survival and disease-free survival
of 12, 24 and 36 months were 98.1% and 98.1%; 94.9% and 93.8%; 83.7% and 76.9%, respectively The overall survival and disease-free survival time was 43.8 ± 0.9 months and 42.5 ± 1.0 months Conclusion: Laparoscopy has the advantages of minimal invasion and prolongs the overall survival and disease-free survival
* Keywords: Rectal cancer; Overall survival; Disease-free survival; Laparoscopic surgery
INTRODUCTION
Surgery is the primary treatment for
rectal cancer, including radical surgery
and temporary surgery such as open
colon surgery for late rectal cancer
Laparoscopic surgery for colorectal was
started in 1991 by Jacobs Laparoscopic
surgery indications for rectal cancer are
not limited to age but need full evaluation
of respiratory function and circulatory
function [2, 3, 4, 8]
Applying laparoscopic techniques to
rectal resection for cancer is a new issue,
leading to effect and advantage in both
surgery and oncology With regard to
postoperative recovery outcomes, the
laparoscopic surgery group had clear
advantages in time to flatus, and ambulation
and hospital stays compared with the open group Laparoscopy has the advantages of minimal invasion and fast recovery, which
is in agreement with many earlier clinical studies [6, 7, 8, 9, 10]
Green B.L et al studied 794 colorectal cancer patients from 27 UK centres, which were randomized to laparoscopic
or open surgery in a 2:1 ratio with median follow-up of all patients was 62.9 months The results showed that there were no statistically significant differences between open and laparoscopic groups in overall survival (78.3 months; 95%CI: 65.8 - 106.6) versus 82.7 (95%CI: 69.1 - 94.8) months, respectively; p = 0.780) and disease-free survival (89.5 months; 95%CI: 67.1 - 121.7) versus 77.0 months (95%CI: 63.3 - 94.0);
p = 0.589) [8]
1 Thanhba Distric Hospital
2 Vietduc Hospital
3 Friendship Hospital
4 103 Military Hospital
Date received: 14/12/2018
Date accepted: 13/02/2019
Trang 2Now, laparoscopic resection is used
widely in the management of rectal
cancer However, the data on long-term
outcomes of rectal cancer are limited
Therefore, the study was conducted with
the aim: To evaluate the overall survival
and disease-free survival of laparoscopic
surgery for rectal cancer
SUBJECTS AND METHODS
1 Subjects
107 patients with rectal cancer who
underwent laparoscopic surgery at Vietduc
Hospital from 6 - 2013 to 06 - 2015
* Patient selection criteria:
- Patient was diagnosed rectal cancer,
that has the distance from lower margin of
tumor to the anus margin < 15 cm
- Histopathology diagnosis was rectal
cancer and laparoscopic radical surgery
for rectal cancer
2 Methods
- Design study: Prospective, longitudinal comparisons to evaluate the overall survival and disease-free survival of laparoscopic surgery for rectal cancer
- Patients undergoing laparoscopic surgery for rectal cancer
- The overall survival and disease-free survival was calculated using the Kaplan-Meier algorithm
RESULTS
Follow-up of 107 rectal cancer patients after laparoscopic surgery with an average duration of 29.3 ± 8.3 months (2 - 47 months),
we found the recurrence rate was 15.0% Mean recurrence time was 26.0 ± 9.8 months (7 - 47 months) and mortality was 9.3%
Table 1: The overall survival and disease-free survival of rectal cancer patients
Time (month)
Mortality (n = 10)
Rate (%) (X ± SE)
Recurrence (n = 16)
Rate (%) (X ± SE)
- The overall survival of 12, 24 and 36 months were 98.1% 94.9% and 83.7%, respectively The overall survival time was 43.8 ± 0.9 months
- The disease-free survival of 12, 24 and 36 months were 98.1%; 93.8% and 76.9%, respectively The disease-free survival time was 42.5 ± 1.0 months
Trang 3Chart 1: The overall survival of rectal cancer patients
Chart 2: The disease-free survival of rectal cancer patients
Trang 4DISCUSSION
To evaluate the outcome of cancer
surgery, the postoperative survival time
should be assessed The overall survival
and disease-free survival of rectal cancer
patients were longer or shorter depends
on the stage of the disease, the tumor's
tissue characteristics, and supportive
treatments [3, 4, 5, 6, 7, 8]
Huang C et al (2015) analyzed 492
rectal cancer patients who underwent the
laparoscopic surgery and 424 cases in
open surgery Overall survival rate of
open surgery and laparoscopic surgery
for 1, 3 and 5 years were 94.0% and
93.6% (p = 0.534), 78.1% and 80.9%
(p = 0.284) and 75.2% and 77.0%
(p = 0.416), respectively Laparoscopy as
an operation for rectal cancer was safe,
produced better immediate outcomes
Long-term survival of laparoscopy revealed
that it was similar to the open operation [9]
Yang Z.F et al (2018) studied 211 pT4
colorectal cancer patients, including
101 cases in the laparoscopy group and
110 cases in the open surgery group [including 15 cases (12.9%) of conversion
to open surgery] The 3-and 5-year overall survival rates were 74.9% and 60.5%, respectively for the laparoscopy group and 62.4% and 46.5%, respectively, for the open group (p = 0.060) The 3-and 5-year disease-free survival rates were
68.0% and 57.3%, respectively, for the laparoscopy group were and 55.8% and 39.8%, respectively, for the open group (p = 0.053) [0]
We monitored 107 rectal cancer patients with a duration of 29.8 ± 8.5 months (1 - 47 months) The overall survival of
12, 24 and 36 months were 98.1%, 94.9%
and 83.7%, respectively The overall survival time was 43.8 ± 0.9 months The disease-free survival of 12, 24 and 36 months were 98.1%; 93.8% and 76.9%, respectively The disease-free survival time was 42.5 ± 1.0 months This result was
similar to some other studies’ (table 2)
Table 2: Overall survival compared with some studies
Green B.L (2013) [8] (62.9 months:
794
78.3 months (p = 0.78)
Huang C et al (2015) [9]
(LAP: Laparoscopic surgery; OP: Open surgery)
Trang 5CONCLUSION
Follow-up of 107 rectal cancer patients
after laparoscopic surgery with an average
duration of 29.3 ± 8.3 months (2 - 47 months),
we found that recurrence rate of 15.0%
with recurrence time was 26.0 ± 9.8 months
The mortality rate was 9.3%
The overall survival and disease-free
survival of 12, 24 and 36 months were
98.1% and 98.1%; 94.9% and 93.8%;
83.7% and 76.9%, respectively The overall
survival and disease-free survival time was
43.8 ± 0.9 months and 42.5 ± 1.0 months
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