Draeger, Teresa and Voelkel, Vinzenz and Schnitzbauer, Valentin and Gerken, Michael and Benz, Stefan and Klinkhammer-Schalke, Monika and Fuerst, Alois (2019) Laparoscopic and open resection of rectal canceris age an effect modifier for short- and long-term survival? INTERNATIONAL JOURNAL OF COLORECTAL DISEASE, 34 (5). pp. 821-828. ISSN 0179-1958, 1432-1262
Full text not available from this repository. (Request a copy)Abstract
IntroductionRectal cancer is a frequently diagnosed tumor worldwide. Various studies have shown the noninferiority or even slight superiority of laparoscopic resection. However, there is no clear recommendation on whether age should influence the choice of surgical approach.Materials and methodsThis study compared outcomes of laparoscopic and open surgery in rectal cancer patients. Perioperative mortality and 5-year overall, relative, and recurrence-free survival rates were analyzed separately for three age groups. Data originate from 30 regional German cancer registries that cover approximately one quarter of the German population. All primary nonmetastatic rectal adenocarcinoma cases with surgery between 2005 and 2014 were eligible for inclusion. To compare survival rates, Kaplan-Meier analysis, a relative survival model, and multivariable Cox regression were used; a sensitivity analysis assessed bias by exclusion.ResultsTen thousand seven hundred fifty-four patients were included in the analysis. The mean laparoscopy rate was 23.0% and increased over time. Analysis of 30-day postoperative mortality rates revealed advantages for laparoscopically treated patients, although the significance level was not reached in any age group. Regarding 5-year overall survival, laparoscopy generally seems to be the superior approach, whereas for recurrence-free survival, an age-dependent gradient in effect size was observed: with a hazard ratio (HR) of 0.703 for laparoscopy, patients under 60years benefitted more from the minimally invasive approach than older patients (septuagenarians, HR 0.923).ConclusionLaparoscopy shows similar results to the open approach in terms of postoperative survival in all age groups. Concerning long-term outcomes, younger patients benefitted most from the minimally invasive approach.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | LOW ANTERIOR RESECTION; COLORECTAL-CANCER; OPEN SURGERY; OUTCOMES; IMPACT; COMORBIDITY; PREVALENCE; RECURRENCE; Bowel cancer; Minimally invasive surgery; Age groups; Health services research; Registries |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Zentren des Universitätsklinikums Regensburg > Tumorzentrum e.V. |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 09 Apr 2020 07:21 |
| Last Modified: | 09 Apr 2020 07:21 |
| URI: | https://pred.uni-regensburg.de/id/eprint/27095 |
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