Laparoscopic Surgery ‘Justified’ for Rectal Cancer

Patients may be able to avoid open surgery for advanced mid or low rectal cancer

medwireNews: Laparoscopic surgery can be justified for rectal cancer patients when performed by well-qualified surgeons, South Korean trial investigators say.

The results of the randomised COREAN (Comparison of Open versus laparoscopic surgery for mid or low REctal cancer After Neoadjuvant chemoradiotherapy) study show no significant differences in 3-year outcomes between patients receiving open versus laparoscopic surgery.

Overall, 72.5% of the 170 open surgery patients achieved 3-year disease-free survival (DFS), as did 79.2% of the 170  laparoscopic surgery patients, with the 6.7% difference falling within the prespecified 15.0% difference for non-inferiority, report Jae Hwan Oh, from the National Cancer Center in Goyang, and co-authors.

The open surgery and laparoscopic surgery patients, who all had cT3N0-2M0 disease, also achieved comparable rates of 3-year overall survival (90.4 vs 91.7%) and local recurrence (4.9 vs 2.6%).

And laparoscopic surgery remained non-inferior to open surgery for 3-year DFS after adjusting for gender and preoperative chemotherapy, as well as pathological T and N classification and tumour regression.

“In patients with mid-rectal or low-rectal cancer treated with preoperative chemoradiotherapy, laparoscopic resection is considered a technically challenging procedure”, the researchers observe in The Lancet Oncology.

“However, if laparoscopic procedures are oncologically safe in such patients, laparoscopic resection would be feasible for most rectal cancers except for cT4 lesions or tumours with threatened circumferential resection margins”, they suggest.

In an accompanying comment, Antonine Brouquet and Bernard Nordlinger, from Assistance Publique–Hôpitaux de Paris in France, hypothesise that the improved DFS noted in laparoscopic surgery patients may be due to reduced surgical insult or improved visualisation that allows total mesorectal excision.

“[E]arly recovery after laparoscopic surgery might facilitate the administration of postoperative treatment in patients with advanced stage”, they add.

Antoine Brouquet and Bernard Nordlinger conclude: “Further studies are now needed to better define the role of the laparoscopic approach in improving oncological outcome in patients undergoing rectal cancer surgery.”

References

Jeong S-Y, Park J, Nam B, et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 2014; Early Online Publication 16 May. doi:10.1016/S1470-2045(14)70205-0

Brouquet A, Nordlinger B. Minimally-invasive approach for rectal cancer surgery. Lancet Oncol 2014; Early Online Publication 16 May. doi:10.1016/S1470-2045(14)70233-5

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