Laparoscopic proctectomy after neoadjuvant therapy: Safety and long-term follow-up

Molly M. Cone, Kim Lu, Daniel Herzig, Jennifer D. Rea, Brian S. Diggs, Samuel C. Oommen

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Purpose The oncologic value of laparoscopic proctectomy for rectal adenocarcinoma is uncertain. Long-term data, particularly in tumors at higher risk of recurrence, is lacking. This study evaluated short- and long-term outcomes in patients who underwent laparoscopic proctectomy for locally advanced cancer (transmural and/or node positive) after neoadjuvant chemoradiotherapy (CRT). Methods This is a retrospective cohort study of 50 consecutive patients with transmural and/or node-positive rectal cancer, from a single surgeon's practice, from 2001 to 2009. All patients were treated with neoadjuvant CRT. All cases were started laparoscopic or hand-assist. Results Of 50 patients, 58% were men, mean age was 60.9 years, and mean body mass index (BMI) was 26.3. The average distance of the tumor from the anal verge was 5.7 cm. All patients completed CRT, and the subsequent mean time to operation was 7.8 weeks. The conversion to open rate was 26%. Thirty-day mortality was 2%. Twentytwo percent had a complete response to CRT. Two patients had positive margins: one developed distant recurrence only, and the other died 2 years later without evidence of local recurrence. The average distal margin was 3.26 cm. The average lymph nodes resected was 11.9. Seven patients had an ileus that delayed discharge and one had a pelvic abscess. Median length of stay was 6 days. Three patients were readmitted within 30 days; all for dehydration. Mean follow-up was 2.72 years. According to Kaplan-Meier analysis, the 5-year local recurrence rate was 9.6%, and the distant recurrence rate was 31%. Five-year disease-specific survival was 80% and overall survival was 68%. Conclusions Patients with locally advanced rectal cancer treated with neoadjuvant therapy can safely undergo laparoscopic proctectomy with a low rate of complications. Oncologic outcomes, including 5-year disease-free survival and local recurrence rates, are comparable to published reports of open proctectomy.

Original languageEnglish (US)
Pages (from-to)1902-1906
Number of pages5
JournalSurgical Endoscopy and Other Interventional Techniques
Volume25
Issue number6
DOIs
StatePublished - Jun 2011

Fingerprint

Neoadjuvant Therapy
Safety
Chemoradiotherapy
Recurrence
Rectal Neoplasms
Neoplasms
Survival
Ileus
Kaplan-Meier Estimate
Dehydration
Abscess
Disease-Free Survival
Length of Stay
Adenocarcinoma
Body Mass Index
Cohort Studies
Retrospective Studies
Hand
Lymph Nodes
Mortality

Keywords

  • Laparoscopy
  • Neoadjuvant therapy
  • Proctectomy
  • Rectal cancer

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopic proctectomy after neoadjuvant therapy : Safety and long-term follow-up. / Cone, Molly M.; Lu, Kim; Herzig, Daniel; Rea, Jennifer D.; Diggs, Brian S.; Oommen, Samuel C.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 25, No. 6, 06.2011, p. 1902-1906.

Research output: Contribution to journalArticle

Cone, Molly M. ; Lu, Kim ; Herzig, Daniel ; Rea, Jennifer D. ; Diggs, Brian S. ; Oommen, Samuel C. / Laparoscopic proctectomy after neoadjuvant therapy : Safety and long-term follow-up. In: Surgical Endoscopy and Other Interventional Techniques. 2011 ; Vol. 25, No. 6. pp. 1902-1906.
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abstract = "Purpose The oncologic value of laparoscopic proctectomy for rectal adenocarcinoma is uncertain. Long-term data, particularly in tumors at higher risk of recurrence, is lacking. This study evaluated short- and long-term outcomes in patients who underwent laparoscopic proctectomy for locally advanced cancer (transmural and/or node positive) after neoadjuvant chemoradiotherapy (CRT). Methods This is a retrospective cohort study of 50 consecutive patients with transmural and/or node-positive rectal cancer, from a single surgeon's practice, from 2001 to 2009. All patients were treated with neoadjuvant CRT. All cases were started laparoscopic or hand-assist. Results Of 50 patients, 58{\%} were men, mean age was 60.9 years, and mean body mass index (BMI) was 26.3. The average distance of the tumor from the anal verge was 5.7 cm. All patients completed CRT, and the subsequent mean time to operation was 7.8 weeks. The conversion to open rate was 26{\%}. Thirty-day mortality was 2{\%}. Twentytwo percent had a complete response to CRT. Two patients had positive margins: one developed distant recurrence only, and the other died 2 years later without evidence of local recurrence. The average distal margin was 3.26 cm. The average lymph nodes resected was 11.9. Seven patients had an ileus that delayed discharge and one had a pelvic abscess. Median length of stay was 6 days. Three patients were readmitted within 30 days; all for dehydration. Mean follow-up was 2.72 years. According to Kaplan-Meier analysis, the 5-year local recurrence rate was 9.6{\%}, and the distant recurrence rate was 31{\%}. Five-year disease-specific survival was 80{\%} and overall survival was 68{\%}. Conclusions Patients with locally advanced rectal cancer treated with neoadjuvant therapy can safely undergo laparoscopic proctectomy with a low rate of complications. Oncologic outcomes, including 5-year disease-free survival and local recurrence rates, are comparable to published reports of open proctectomy.",
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T2 - Safety and long-term follow-up

AU - Cone, Molly M.

AU - Lu, Kim

AU - Herzig, Daniel

AU - Rea, Jennifer D.

AU - Diggs, Brian S.

AU - Oommen, Samuel C.

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N2 - Purpose The oncologic value of laparoscopic proctectomy for rectal adenocarcinoma is uncertain. Long-term data, particularly in tumors at higher risk of recurrence, is lacking. This study evaluated short- and long-term outcomes in patients who underwent laparoscopic proctectomy for locally advanced cancer (transmural and/or node positive) after neoadjuvant chemoradiotherapy (CRT). Methods This is a retrospective cohort study of 50 consecutive patients with transmural and/or node-positive rectal cancer, from a single surgeon's practice, from 2001 to 2009. All patients were treated with neoadjuvant CRT. All cases were started laparoscopic or hand-assist. Results Of 50 patients, 58% were men, mean age was 60.9 years, and mean body mass index (BMI) was 26.3. The average distance of the tumor from the anal verge was 5.7 cm. All patients completed CRT, and the subsequent mean time to operation was 7.8 weeks. The conversion to open rate was 26%. Thirty-day mortality was 2%. Twentytwo percent had a complete response to CRT. Two patients had positive margins: one developed distant recurrence only, and the other died 2 years later without evidence of local recurrence. The average distal margin was 3.26 cm. The average lymph nodes resected was 11.9. Seven patients had an ileus that delayed discharge and one had a pelvic abscess. Median length of stay was 6 days. Three patients were readmitted within 30 days; all for dehydration. Mean follow-up was 2.72 years. According to Kaplan-Meier analysis, the 5-year local recurrence rate was 9.6%, and the distant recurrence rate was 31%. Five-year disease-specific survival was 80% and overall survival was 68%. Conclusions Patients with locally advanced rectal cancer treated with neoadjuvant therapy can safely undergo laparoscopic proctectomy with a low rate of complications. Oncologic outcomes, including 5-year disease-free survival and local recurrence rates, are comparable to published reports of open proctectomy.

AB - Purpose The oncologic value of laparoscopic proctectomy for rectal adenocarcinoma is uncertain. Long-term data, particularly in tumors at higher risk of recurrence, is lacking. This study evaluated short- and long-term outcomes in patients who underwent laparoscopic proctectomy for locally advanced cancer (transmural and/or node positive) after neoadjuvant chemoradiotherapy (CRT). Methods This is a retrospective cohort study of 50 consecutive patients with transmural and/or node-positive rectal cancer, from a single surgeon's practice, from 2001 to 2009. All patients were treated with neoadjuvant CRT. All cases were started laparoscopic or hand-assist. Results Of 50 patients, 58% were men, mean age was 60.9 years, and mean body mass index (BMI) was 26.3. The average distance of the tumor from the anal verge was 5.7 cm. All patients completed CRT, and the subsequent mean time to operation was 7.8 weeks. The conversion to open rate was 26%. Thirty-day mortality was 2%. Twentytwo percent had a complete response to CRT. Two patients had positive margins: one developed distant recurrence only, and the other died 2 years later without evidence of local recurrence. The average distal margin was 3.26 cm. The average lymph nodes resected was 11.9. Seven patients had an ileus that delayed discharge and one had a pelvic abscess. Median length of stay was 6 days. Three patients were readmitted within 30 days; all for dehydration. Mean follow-up was 2.72 years. According to Kaplan-Meier analysis, the 5-year local recurrence rate was 9.6%, and the distant recurrence rate was 31%. Five-year disease-specific survival was 80% and overall survival was 68%. Conclusions Patients with locally advanced rectal cancer treated with neoadjuvant therapy can safely undergo laparoscopic proctectomy with a low rate of complications. Oncologic outcomes, including 5-year disease-free survival and local recurrence rates, are comparable to published reports of open proctectomy.

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KW - Rectal cancer

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