Laparoscopic Surgery Does Not Compromise Long-Term Survival Outcomes in Rectal Cancer

Colon cancer
Computer illustration of a malignant (cancerous) tumour (red) in the colon. Risk factors for colorectal cancer are smoking, obesity and lack of physical activity.
Researchers assessed the safety of laparoscopic surgery vs open surgery for rectal cancer using 10-year follow-up data.

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.

Reference

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