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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/15507

Title: Outcome following laparoscopic and open total mesorectal excision for rectal cancer
Authors: Penninckx, F.
Kartheuser, A.
Van de Stadt, J.
Pattyn, P.
Mansvelt, B.
Bertrand, C.
Van Eycken, E.
Jegou, D.
Fieuws, S.
Issue Date: 2013
Citation: BRITISH JOURNAL OF SURGERY, 100 (10), p. 1368-1375
Abstract: Background: There are few reports on the oncological quality of resection and outcome after laparoscopic versus open total mesorectal excision (TME) for rectal cancer in everyday surgical practice. Methods: Between January 2006 and October 2011, data for patients with mid or low rectal adenocarcinoma who underwent elective TME were recorded in the PROCARE database. A multivariable model and the propensity score as a co-variable in Cox or logistic regression models were used for adjustment of differences in patient mix and non-random assignment of surgical approach. Results: Data for 2660 patients from 82 hospitals were recorded. Implementation of laparoscopic TME was highly variable. The oncological quality of resection was similar in the laparoscopic and the open group: incomplete mesorectal excision in 13·2 and 11·4 per cent respectively, circumferential resection margin positivity in 18·1 per cent, and a median of 11 lymph nodes examined per specimen in both groups. The hazard ratio for survival after laparoscopic versus open TME was 1·05 (95 per cent confidence interval 0·88 to 1·24) after correction for differences in patient mix, and 1·06 (0·89 to 1·25) after correction for the propensity score. The definitive colostomy rate was similar in the two groups: 31·0 per cent after open and 31·4 per cent after laparoscopic TME. Postoperative morbidity was lower and length of stay was shorter after laparoscopic TME compared with open TME. Survival was not negatively affected by converted laparoscopic resection, whereas postoperative morbidity, mortality and length of stay after converted laparoscopy were comparable with those after open TME. Conclusion: Oncological outcome is comparable after laparoscopic and open TME in everyday surgical practice.
Notes: Correspondence to: Dr F. Penninckx, Department of Abdominal Surgery, UZ Gasthuisberg, Herestraat 49, 3000 – Leuven, Belgium (e-mail: freddy.penninckx@uzleuven.be)
URI: http://hdl.handle.net/1942/15507
DOI: 10.1002/bjs.9211
ISI #: 000322960000016
ISSN: 0007-1323
Category: A1
Type: Journal Contribution
Validation: ecoom, 2014
Appears in Collections: Research publications

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