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M A Gok, H N Mughal, M Bughio, U A Khan, ThTP4.1 Evaluation of Post-operative Outcomes in Laparoscopic & Open Anterior Resections (AR) for Rectal Cancer: A 15 year cohort study, British Journal of Surgery, Volume 110, Issue Supplement_6, September 2023, znad241.273, https://doi.org/10.1093/bjs/znad241.273
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Abstract
AR offers sphincter preserving surgery for rectal cancers, & has functionally comparable results to APER's or Hartmann’s resection. Use of mechanical stapling devices has allowed laparoscopic AR to become widely available. Aim of study is to evaluate post-operative outcomes in laparoscopic AR’s.
A cohort study collated post-operative outcomes in laparoscopic AR’s performed at a single-centre from January 2008 to February 2023. Open AR’s were recruited as controls.
| . | Laparoscopic AR (n = 276) . | Open AR (n = 122) . | Mann Whitney U (p value) . |
|---|---|---|---|
| Age (yrs) | 67 | 69 | NS |
| Sex (M : F) | 165 : 111 | 77 : 45 | NS |
| ASA (median) | 2 | 2 | NS |
| BMI | 26 | 27 | NS |
| Short : long course DXT (n) | 49 : 27 | 32 : 17 | NS |
| Operation time (mins) | 246 | 180 | < 0.0001 |
| High AR (>12cm) | 179 | 58 | |
| Low AR (6 – 12cm) | 91 | 57 | |
| Ultra low (< 6cm) | 6 | 7 | |
| LN harvest | 17 | 15 | NS |
| LOS (days) | 6 | 10 | < 0.0001 |
| 90 days mortality (n) | 4 | 2 | NS |
| Complications (n) | |||
| Leaks | 17 | 15 | NS |
| Ileus | 35 | 20 | NS |
| HAP | 24 | 13 | NS |
| Anaemia (transfusion) | 4 | 6 | NS |
| Wound infections | 20 | 8 | NS |
| Survival rates yr (%) | |||
| 1st | 99.3 | 95.2 | |
| 5th | 92.4 | 78.2 | Logrank |
| 10th | 88.0 | 69.2 | p < 0.0001 |
| 15th | 88.0 | 64.5 | (Uncensored) |
| . | Laparoscopic AR (n = 276) . | Open AR (n = 122) . | Mann Whitney U (p value) . |
|---|---|---|---|
| Age (yrs) | 67 | 69 | NS |
| Sex (M : F) | 165 : 111 | 77 : 45 | NS |
| ASA (median) | 2 | 2 | NS |
| BMI | 26 | 27 | NS |
| Short : long course DXT (n) | 49 : 27 | 32 : 17 | NS |
| Operation time (mins) | 246 | 180 | < 0.0001 |
| High AR (>12cm) | 179 | 58 | |
| Low AR (6 – 12cm) | 91 | 57 | |
| Ultra low (< 6cm) | 6 | 7 | |
| LN harvest | 17 | 15 | NS |
| LOS (days) | 6 | 10 | < 0.0001 |
| 90 days mortality (n) | 4 | 2 | NS |
| Complications (n) | |||
| Leaks | 17 | 15 | NS |
| Ileus | 35 | 20 | NS |
| HAP | 24 | 13 | NS |
| Anaemia (transfusion) | 4 | 6 | NS |
| Wound infections | 20 | 8 | NS |
| Survival rates yr (%) | |||
| 1st | 99.3 | 95.2 | |
| 5th | 92.4 | 78.2 | Logrank |
| 10th | 88.0 | 69.2 | p < 0.0001 |
| 15th | 88.0 | 64.5 | (Uncensored) |
| . | Laparoscopic AR (n = 276) . | Open AR (n = 122) . | Mann Whitney U (p value) . |
|---|---|---|---|
| Age (yrs) | 67 | 69 | NS |
| Sex (M : F) | 165 : 111 | 77 : 45 | NS |
| ASA (median) | 2 | 2 | NS |
| BMI | 26 | 27 | NS |
| Short : long course DXT (n) | 49 : 27 | 32 : 17 | NS |
| Operation time (mins) | 246 | 180 | < 0.0001 |
| High AR (>12cm) | 179 | 58 | |
| Low AR (6 – 12cm) | 91 | 57 | |
| Ultra low (< 6cm) | 6 | 7 | |
| LN harvest | 17 | 15 | NS |
| LOS (days) | 6 | 10 | < 0.0001 |
| 90 days mortality (n) | 4 | 2 | NS |
| Complications (n) | |||
| Leaks | 17 | 15 | NS |
| Ileus | 35 | 20 | NS |
| HAP | 24 | 13 | NS |
| Anaemia (transfusion) | 4 | 6 | NS |
| Wound infections | 20 | 8 | NS |
| Survival rates yr (%) | |||
| 1st | 99.3 | 95.2 | |
| 5th | 92.4 | 78.2 | Logrank |
| 10th | 88.0 | 69.2 | p < 0.0001 |
| 15th | 88.0 | 64.5 | (Uncensored) |
| . | Laparoscopic AR (n = 276) . | Open AR (n = 122) . | Mann Whitney U (p value) . |
|---|---|---|---|
| Age (yrs) | 67 | 69 | NS |
| Sex (M : F) | 165 : 111 | 77 : 45 | NS |
| ASA (median) | 2 | 2 | NS |
| BMI | 26 | 27 | NS |
| Short : long course DXT (n) | 49 : 27 | 32 : 17 | NS |
| Operation time (mins) | 246 | 180 | < 0.0001 |
| High AR (>12cm) | 179 | 58 | |
| Low AR (6 – 12cm) | 91 | 57 | |
| Ultra low (< 6cm) | 6 | 7 | |
| LN harvest | 17 | 15 | NS |
| LOS (days) | 6 | 10 | < 0.0001 |
| 90 days mortality (n) | 4 | 2 | NS |
| Complications (n) | |||
| Leaks | 17 | 15 | NS |
| Ileus | 35 | 20 | NS |
| HAP | 24 | 13 | NS |
| Anaemia (transfusion) | 4 | 6 | NS |
| Wound infections | 20 | 8 | NS |
| Survival rates yr (%) | |||
| 1st | 99.3 | 95.2 | |
| 5th | 92.4 | 78.2 | Logrank |
| 10th | 88.0 | 69.2 | p < 0.0001 |
| 15th | 88.0 | 64.5 | (Uncensored) |
Laparoscopic AR accounted for prolonged operative times & shorter hospital stay. There were no differences in early post operative mortality & complications. Laparoscopic AR had better long term survival, This could be explained by better case selection for laparoscopic AR (since laparoscopic resection were adopted as routine practise, as opposed to open AR became less employed in recent years).
