In patients with rectal cancer, laparoscopic surgery does not compromise long-term survival outcomes when performed by well-trained surgeons, according to a study published in The Lancet Gastroenterology & Hepatology.
The long-term outcomes of laparoscopic surgery for rectal cancer remain controversial. Therefore, researchers studied the oncological safety of laparoscopic surgery for patients with rectal cancer using 10-year follow-up data from the Comparison of Open versus laparoscopic surgery for mid or low REctal cancer After Neoadjuvant chemoradiotherapy (COREAN) trial (ClinicalTrials.gov Identifier: NCT00470951).
This trial was an open-label, non-inferiority, randomized controlled trial in which eligible participants had middle or low rectal cancer with lesions located within 9 cm of the anal verge, and had been previously treated with preoperative chemoradiotherapy. Patients were randomly assigned to open or laparoscopic surgery, which was performed 6 to 8 weeks after the administration of preoperative concurrent chemoradiotherapy over a 5.5 week period. Postoperative adjuvant chemotherapy was administered for 4 months.
Of the 340 patients enrolled in the COREAN trial (170 patients in the open surgery group and 170 in the laparoscopic group), 2 patients in the laparoscopic surgery group were lost to follow-up and were not included in the 10-year analysis.
Over a median duration of follow-up of 143 months, the researchers observed no differences between the open surgery group and laparoscopic surgery group in 10-year overall survival (74.1% vs 76.8%; P =.44), 10-year disease-free survival (59.3% vs 64.3%; P =.20), or 10-year local recurrence (8.9% vs 3.4%; P =.050), respectively. The stratified hazard ratios for open surgery vs laparoscopic surgery were 0.94 for overall survival, 1.05 for disease-free survival, and 2.22 for local recurrence.
“In conclusion, the 10-year follow-up analysis of the COREAN trial showed that laparoscopic surgery for locally advanced rectal cancer after preoperative chemo-radiotherapy can provide survival outcomes similar to those of open surgery,” stated the authors.
Park JW, Kang S-B, Hao J, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): 10-year follow-up of an open-label, non-inferiority, randomised controlled trial. Lancet Gastroenterol Hepatol. 2021;6(7): 569-577. doi: 10.1016/S2468-1253(21)00094-7