[Comment] Long term oncological outcomes for laparoscopic versus open surgery for rectal cancer-a population-based na tionwide noninferiority study
[Aim] The aim of this work was to compare the 5-year overall survival in a national cohort of patients undergoing curative abdominal resection for rectal cancer by laparoscopic (LAP) or open (OPEN) surgery. [Method] All patients diagnosed with clinical Stage I-III rectal cancer and who underwent LAP...
Saved in:
| Main Author: | |
|---|---|
| Format: | Article |
| Language: | zho |
| Published: |
Editorial Office of Journal of Colorectal & Anal Surgery
2022-08-01
|
| Series: | 结直肠肛门外科 |
| Online Access: | https://jcas.gxmuyfy.cn/cn/wqll/paper.html?id=392&cateName=2022%E5%B9%B4%20%E7%AC%AC28%E5%8D%B7%20%E7%AC%AC4%E6%9C%9F |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850085006589820928 |
|---|---|
| author | Tang Bin |
| author_facet | Tang Bin |
| author_sort | Tang Bin |
| collection | DOAJ |
| description | [Aim] The aim of this work was to compare the 5-year overall survival in a national cohort of patients undergoing curative abdominal resection for rectal cancer by laparoscopic (LAP) or open (OPEN) surgery. [Method] All patients diagnosed with clinical Stage I-III rectal cancer and who underwent LAP or OPEN abdominal curative surgery in Sweden between 2010 and 2016 were retrieved from the Swedish Colorectal Cancer Registry. A noninferiority study design was employed with a statistical power of 90%, a one-side type I error of 2.5% and a noninferiority margin of 2%. The analyses were performed as intention-to-treat and the relationship between surgical technique and overall mortality within 5 years was analysed. Multilevel regression models with the patients matched by propensity scores adjusted for patient- and tumour-related variables were used. [Results] A total of 8410 Stage I-III cancer patients were included. This group underwent 2094 LAP (24.9%) and 6316 OPEN (75.1%) procedures and were followed until 31 December 2020. Multivariable Cox regression demonstrated that 5-year overall survival was higher in the LAP group [hazard ratio (HR) 0.877; 95% CI 0.775-0.993]. [Correction added on 21 November 2022, after first online publication: In the preceding sentence, the CI value for LAP group has been corrected from "0.877" to "0.775" in this version.] The outcome was similar when multiple imputation and propensity score matching were employed. When cT4 patients were excluded there was no difference (HR 0.885; 95% CI 0.790-1.033). At 5-years' follow-up local recurrence was not different, at 2.9% for the LAP group and 3.6% for the OPEN group (p = 0.075), while metastatic disease was more frequent in the OPEN group (19.6% compared with 15.6% for LAP; p < 0.001). [Conclusion] This study demonstrated that the LAP technique was not inferior to OPEN surgery with regard to overall 5-year survival. These results support the use of laparoscopic surgery. |
| format | Article |
| id | doaj-art-582bdf3a481842e39a6cf6ac8d7bd9bb |
| institution | DOAJ |
| issn | 1674-0491 |
| language | zho |
| publishDate | 2022-08-01 |
| publisher | Editorial Office of Journal of Colorectal & Anal Surgery |
| record_format | Article |
| series | 结直肠肛门外科 |
| spelling | doaj-art-582bdf3a481842e39a6cf6ac8d7bd9bb2025-08-20T02:43:50ZzhoEditorial Office of Journal of Colorectal & Anal Surgery结直肠肛门外科1674-04912022-08-0128440840910.19668/j.cnki.issn1674-0491.2022.04.021[Comment] Long term oncological outcomes for laparoscopic versus open surgery for rectal cancer-a population-based na tionwide noninferiority studyTang Bin0Department of General Surgery I, Xiangtan Central Hospital, Xiangtan 410100, Hunan Province, China[Aim] The aim of this work was to compare the 5-year overall survival in a national cohort of patients undergoing curative abdominal resection for rectal cancer by laparoscopic (LAP) or open (OPEN) surgery. [Method] All patients diagnosed with clinical Stage I-III rectal cancer and who underwent LAP or OPEN abdominal curative surgery in Sweden between 2010 and 2016 were retrieved from the Swedish Colorectal Cancer Registry. A noninferiority study design was employed with a statistical power of 90%, a one-side type I error of 2.5% and a noninferiority margin of 2%. The analyses were performed as intention-to-treat and the relationship between surgical technique and overall mortality within 5 years was analysed. Multilevel regression models with the patients matched by propensity scores adjusted for patient- and tumour-related variables were used. [Results] A total of 8410 Stage I-III cancer patients were included. This group underwent 2094 LAP (24.9%) and 6316 OPEN (75.1%) procedures and were followed until 31 December 2020. Multivariable Cox regression demonstrated that 5-year overall survival was higher in the LAP group [hazard ratio (HR) 0.877; 95% CI 0.775-0.993]. [Correction added on 21 November 2022, after first online publication: In the preceding sentence, the CI value for LAP group has been corrected from "0.877" to "0.775" in this version.] The outcome was similar when multiple imputation and propensity score matching were employed. When cT4 patients were excluded there was no difference (HR 0.885; 95% CI 0.790-1.033). At 5-years' follow-up local recurrence was not different, at 2.9% for the LAP group and 3.6% for the OPEN group (p = 0.075), while metastatic disease was more frequent in the OPEN group (19.6% compared with 15.6% for LAP; p < 0.001). [Conclusion] This study demonstrated that the LAP technique was not inferior to OPEN surgery with regard to overall 5-year survival. These results support the use of laparoscopic surgery.https://jcas.gxmuyfy.cn/cn/wqll/paper.html?id=392&cateName=2022%E5%B9%B4%20%E7%AC%AC28%E5%8D%B7%20%E7%AC%AC4%E6%9C%9F |
| spellingShingle | Tang Bin [Comment] Long term oncological outcomes for laparoscopic versus open surgery for rectal cancer-a population-based na tionwide noninferiority study 结直肠肛门外科 |
| title | [Comment] Long term oncological outcomes for laparoscopic versus open surgery for rectal cancer-a population-based na tionwide noninferiority study |
| title_full | [Comment] Long term oncological outcomes for laparoscopic versus open surgery for rectal cancer-a population-based na tionwide noninferiority study |
| title_fullStr | [Comment] Long term oncological outcomes for laparoscopic versus open surgery for rectal cancer-a population-based na tionwide noninferiority study |
| title_full_unstemmed | [Comment] Long term oncological outcomes for laparoscopic versus open surgery for rectal cancer-a population-based na tionwide noninferiority study |
| title_short | [Comment] Long term oncological outcomes for laparoscopic versus open surgery for rectal cancer-a population-based na tionwide noninferiority study |
| title_sort | comment long term oncological outcomes for laparoscopic versus open surgery for rectal cancer a population based na tionwide noninferiority study |
| url | https://jcas.gxmuyfy.cn/cn/wqll/paper.html?id=392&cateName=2022%E5%B9%B4%20%E7%AC%AC28%E5%8D%B7%20%E7%AC%AC4%E6%9C%9F |
| work_keys_str_mv | AT tangbin commentlongtermoncologicaloutcomesforlaparoscopicversusopensurgeryforrectalcancerapopulationbasednationwidenoninferioritystudy |