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Outcomes of open versus laparoscopic surgery in patients with rectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The goal of this study was to compare the effectiveness of laparoscopic with that of open surgery up to 2 years after intervention in patients with rectal cancer.

Methods

This is a prospective cohort study of patients with rectal cancer who underwent surgery (laparoscopic or open) between June 2010 and December 2012 in 22 acute hospitals. Main outcomes were mortality, complications, reoperation, readmission, and patient-reported outcome measures (PROMs), as measured using the EuroQol-5D (EQ-5D), European Organisation for Research and Treatment of Cancer (EORTC) QLQ-Q30 and Q29, the Barthel Index (BI), and the Duke-UNC Functional Social Support Questionnaire at baseline, 1 year, and 2 years after surgery. Multivariable multilevel logistic regression and generalized linear models were used in the analyses after adjusting for specific propensity scores developed for each outcome and time point.

Results

In the multivariable analysis, rates of some medical complications after surgery during admission (renal failure and paralytic ileus) and infectious (urinary tract infection, septic shock, and localized intra-abdominal infection) and at 1 year (renal and heart failure) were higher among patients who underwent open surgery than among those who underwent laparoscopic surgery. There were no differences between the two surgical approaches in all other parameters assessed at the different time points or in all PROMs evaluated.

Conclusions

Laparoscopic surgery and open surgery provide quite similar results in patients with rectal cancer up to 2 years after intervention in most outcomes, though the rates of certain medical and infectious complications at admission and up to 1 year after the intervention were higher in open surgery.

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Acknowledgements

The REDISSEC CARESS-CCR (Results and Health Services Research in Colorectal Cancer) group:

Jose María Quintana López (Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao-Bizkaia/Red de Investigación en Servicios de Salud en Enfermedades Crónicas – REDISSEC), Marisa Baré Mañas (Epidemiologia Clínica y Cribado de Cancer, Corporació Sanitaria Parc Taulí, Sabadell/Red de Investigación en Servicios de Salud en Enfermedades Crónicas – REDISSEC), Maximino Redondo Bautista (Servicio de Laboratorio, Hospital Costa del Sol, Málaga/REDISSEC), Eduardo Briones Pérez de la Blanca (Unidad de Epidemiología, Distrito Sevilla, Servicio Andaluz de Salud), Nerea Fernández de Larrea Baz (Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid/REDISSEC), Cristina Sarasqueta Eizaguirre (Unidad de Investigación, Hospital Universitario Donostia/Instituto de Investigación Sanitaria Biodonostia, Donostia – REDISSEC), Antonio Escobar Martínez (Unidad de Investigación, Hospital Universitario Basurto, Bilbao/REDISSEC), Francisco Rivas Ruiz (Servicio de Epidemiología, Hospital Costa del Sol, Málaga – REDISSEC), Maria M Morales-Suárez-Varela (Department of Preventive Medicine and Public Health, University of Valencia/CIBER de Epidemiología y Salud Pública (CIBERESP)/CSISP-FISABIO, Valencia), Juan Antonio Blasco Amaro (Unidad de Evaluación de Tecnologías Sanitarias, Agencia Laín Entralgo, Madrid), Isabel del Cura González (Unidad Apoyo a Docencia-Investigación, Dirección Técnica Docencia e Investigación Gerencia Adjunta Planificación, Gerencia de Atención Primaria de la Consejería de Sanidad de la Comunidad Autónoma de Madrid), Inmaculada Arostegui Madariaga (Departamento de Matemática Aplicada, Estadística e Investigación Operativa, UPV- REDISSEC), Amaia Bilbao González (Unidad de Investigación, Hospital Universitario Basurto, Bilbao/REDISSEC), Nerea González Hernández (Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao-Bizkaia/Red de Investigación en Servicios de Salud en Enfermedades Crónicas – REDISSEC), Susana García-Gutiérrez (Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao-Bizkaia/Red de Investigación en Servicios de Salud en Enfermedades Crónicas – REDISSEC), Iratxe Lafuente Guerrero (Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao-Bizkaia/Red de Investigación en Servicios de Salud en Enfermedades Crónicas – REDISSEC), Urko Aguirre Larracoechea (Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao-Bizkaia/Red de Investigación en Servicios de Salud en Enfermedades Crónicas – REDISSEC), Miren Orive Calzada (Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao-Bizkaia/Red de Investigación en Servicios de Salud en Enfermedades Crónicas – REDISSEC), Josune Martin Corral (Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao-Bizkaia/Red de Investigación en Servicios de Salud en Enfermedades Crónicas – REDISSEC), Ane Antón-Ladislao (Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao-Bizkaia/Red de Investigación en Servicios de Salud en Enfermedades Crónicas – REDISSEC), Núria Torà (Epidemiologia Clínica y Cribado de Cancer, Corporació Sanitaria Parc Taulí, Sabadell/REDISSEC), Marina Pont (Epidemiologia Clínica y Cribado de Cancer, Corporació Sanitaria Parc Taulí, Sabadell/REDISSEC), María Purificación Martínez del Prado (Servicio de Oncología, Hospital Universitario Basurto, Bilbao), Alberto Loizate Totorikaguena (Servicio de Cirugía General, Hospital Universitario Basurto, Bilbao), Ignacio Zabalza Estévez (Servicio de Anatomía Patológica, Hospital Galdakao-Usansolo, Galdakao), José Errasti Alustiza (Servicio de Cirugía General, Hospital Universitario Araba, Vitoria-Gasteiz), Antonio Z Gimeno García (Servicio de Gastroenterología, Hospital Universitario de Canarias, La Laguna), Santiago Lázaro Aramburu (Servicio de Cirugía General, Hospital Galdakao-Usansolo, Galdakao), Mercè Comas Serrano (IMAS-Hospital del Mar, Barcelona), Jose María Enríquez Navascues (Servicio de Cirugía General y Digestiva, Hospital Universitario Donostia), Carlos Placer Galán (Servicio de Cirugía General y Digestiva, Hospital Universitario Donostia), Amaia Perales (Instituto de Investigación Sanitaria Biodonostia, Donostia), Iñaki Urkidi Valmaña (Servicio de Cirugía General y Digestiva, Hospital de Mendaro), Jose María Erro Azkárate (Servicio de Cirugía General y Digestiva, Hospital de Zumárraga), Enrique Cormenzana Lizarribar (Servicio de Cirugía General y Digestiva, Hospital del Bidasoa), Adelaida Lacasta Muñoa (Servicio de Oncología Médica, Hospital Universitario Donostia), Pep Piera Pibernat (Servicio de Oncología Médica, Hospital Universitario Donostia), Elena Campano Cuevas (Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Sevilla), Ana Isabel Sotelo Gómez (Servicio de Cirugía, Hospital Universitario Virgen de Valme, Sevilla), Segundo Gómez-Abril (Servicio de Cirugía General y Aparato Digestivo, Hospital Dr. Pesset, Valencia), F Medina-Cano (Servicio de Cirugía General y Aparato Digestivo, Agencia Sanitaria Costa del Sol, Marbella), Julia Alcaide (Servicio de Oncología Médica, Agencia Sanitaria Costa del Sol, Marbella), Arturo Del Rey-Moreno (Servicio de Cirugía, Hospital de Antequera), Manuel Jesús Alcántara (Coloproctology Unit, General and Digestive Surgery Service, Corporació Sanitaria Parc Taulí, Sabadell), Rafael Campo (Digestive Diseases Department, Corporació Sanitaria Parc Taulí, Sabadell), Alex Casalots (Pathology Service, Corporació Sanitaria Parc Taulí, Sabadell), Carles Pericay (Medical Oncology Department, Corporació Sanitaria Parc Taulí, Sabadell/REDISSEC), Maria José Gil (General and Digestive Surgery Service, Parc de Salut Mar, Barcelona), Miquel Pera (General and Digestive Surgery Service, Parc de Salut Mar, Barcelona), Pablo Collera (General and Digestive Surgery Service, Althaia- Xarxa Assistencial Universitaria, Manresa), Josep Alfons Espinàs (Catalonian Cancer Strategy Unit, Department of Health, Institut Català d’Oncología), Mercedes Martínez (Medical Oncology Department, Institut Català d’Oncología), Mireia Espallargues (Agency for Health Quality and Assessment of Catalonia – AquAS – and REDISSEC), Caridad Almazán (Agency for Health Quality and Assessment of Catalonia – AQuAS – CIBER de Epidemiología y Salud Pública – CIBERESP), Paula Dujovne Lindenbaum (Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Fundación Alcorcón, Madrid), José María Fernández-Cebrián (Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Fundación Alcorcón, Madrid), Rocío Anula Fernández (Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Clínico San Carlos, Madrid), Julio Ángel Mayol Martínez (Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Clínico San Carlos, Madrid), Ramón Cantero Cid (Servicio Cirugía General y del Aparato Digestivo, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid), Héctor Guadalajara Labajo (Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Paz, Madrid), María Heras Garceau (Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Paz, Madrid), Damián García Olmo (Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Paz, Madrid), Mariel Morey Montalvo (REDISSEC, Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria de la Comunidad de Madrid, Madrid), Javier Mar (REDISSEC, Unidad de Gestión Sanitaria, Hospital del Alto Deba, Mondragon-Arrasate, Spain).

Funding

This work was supported in part by grants from the Instituto de Salud Carlos III and European Regional Development Funds – ERDF (PS09/00314, PS09/00910, PS09/00746, PS09/00805, PI09/90460, PI09/90490, PI09/90453, PI09/90441, PI09/90397); Department of Health of the Basque Country (2010111098); Research Committee of the Hospital Galdakao; and the thematic networks REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas) of the Instituto de Salud Carlos III.

Author information

Authors and Affiliations

  1. Unidad de Investigación, Hospital Galdakao-Usansolo, Barrio Labeaga s/n, 48960, Galdakao, Biscay, Spain

    José M. Quintana, Ane Anton-Ladislao, Nerea Gonzalez & Susana Garcia-Gutierrez

  2. Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Madrid, Spain

    José M. Quintana, Ane Anton-Ladislao, Santiago Lázaro, Nerea Gonzalez, Marisa Bare, Maximino Redondo, Antonio Escobar, Cristina Sarasqueta & Susana Garcia-Gutierrez

  3. Servicio de Cirugía General, Hospital Galdakao-Usansolo, Galdakao, Biscay, Spain

    Santiago Lázaro

  4. Unidad de Epidemiología Clínica, Corporacio Parc Tauli, Barcelona, Spain

    Marisa Bare

  5. Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain

    Nerea Fernandez de Larrea

  6. CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain

    Nerea Fernandez de Larrea

  7. Unidad de Investigación, Hospital Costa del Sol, Malaga, Spain

    Maximino Redondo

  8. UDG Salud Publica, Distrito AP Sevilla, Sevilla, Spain

    Eduardo Briones

  9. Unidad de Investigación, Hospital Basurto, Bilbao, Biscay, Spain

    Antonio Escobar

  10. Unidad de Investigación, Hospital Donostia/Biodonostia, Donostia, Gipuzkoa, Spain

    Cristina Sarasqueta

Authors
  1. José M. Quintana
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  2. Ane Anton-Ladislao
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  3. Santiago Lázaro
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  4. Nerea Gonzalez
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  5. Marisa Bare
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  6. Nerea Fernandez de Larrea
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  7. Maximino Redondo
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  8. Eduardo Briones
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  9. Antonio Escobar
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  11. Susana Garcia-Gutierrez
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Consortia

for the REDISSEC-CARESS/CCR group

Contributions

We are grateful for the support of the 22 participating hospitals, as well as the staff members of the various services, research departments, quality units, and medical records sections of these hospitals. We also gratefully acknowledge the patients who participated in the study. The authors also would like to thank Editage (www.editage.com) for English language editing.

Corresponding author

Correspondence to José M. Quintana.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Quintana, J.M., Anton-Ladislao, A., Lázaro, S. et al. Outcomes of open versus laparoscopic surgery in patients with rectal cancer. Int J Colorectal Dis 33, 99–103 (2018). https://doi.org/10.1007/s00384-017-2925-2

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  • DOI: https://doi.org/10.1007/s00384-017-2925-2

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