Overall Survival And Disease-Free Survival Of Laparoscopic Surgery For Rectal Cancer – Pham Thai Ha

Journal of military pharmaco-medicine n o 3-2019 140 OVERALL SURVIVAL AND DISEASE-FREE SURVIVAL OF LAPAROSCOPIC SURGERY FOR RECTAL CANCER Pham Thai Ha1; Nguyen Xuan Hung2 Nguyen Quoc Dung3; Nguyen Van Xuyen4 SUMMARY Objectives: To evaluate the overall survival and disease-free survival of laparoscopic surgery for rectal cancer. Subjects and methods: 107 patients with rectal cancer who underwent laparoscopic surgery, overall survival and disease-free survival after laparoscopic surgery was calculated using the Kaplan-Meier test. Results: The overall survival and disease-free survival of 12, 24 and 36 months were 98.1% and 98.1%; 94.9% and 93.8%; 83.7% and 76.9%, respectively. The overall survival and disease-free survival time was 43.8 ± 0.9 months and 42.5 ± 1.0 months. Conclusion: Laparoscopy has the advantages of minimal invasion and prolongs the overall survival and disease-free survival. * Keywords: Rectal cancer; Overall survival; Disease-free survival; Laparoscopic surgery. INTRODUCTION Surgery is the primary treatment for rectal cancer, including radical surgery and temporary surgery such as open colon surgery for late rectal cancer. Laparoscopic surgery for colorectal was started in 1991 by Jacobs. Laparoscopic surgery indications for rectal cancer are not limited to age but need full evaluation of respiratory function and circulatory function [2, 3, 4, 8]. Applying laparoscopic techniques to rectal resection for cancer is a new issue, leading to effect and advantage in both surgery and oncology. With regard to postoperative recovery outcomes, the laparoscopic surgery group had clear advantages in time to flatus, and ambulation and hospital stays compared with the open group. Laparoscopy has the advantages of minimal invasion and fast recovery, which is in agreement with many earlier clinical studies [6, 7, 8, 9, 10]. Green B.L et al studied 794 colorectal cancer patients from 27 UK centres, which were randomized to laparoscopic or open surgery in a 2:1 ratio with median follow-up of all patients was 62.9 months. The results showed that there were no statistically significant differences between open and laparoscopic groups in overall survival (78.3 months; 95%CI: 65.8 - 106.6) versus 82.7 (95%CI: 69.1 - 94.8) months, respectively; p = 0.780) and disease-free survival (89.5 months; 95%CI: 67.1 - 121.7) versus 77.0 months (95%CI: 63.3 - 94.0); p = 0.589) [8]. 1. Thanhba Distric Hospital 2. Vietduc Hospital 3. Friendship Hospital 4. 103 Military Hospital Corresponding author: Pham Thai Ha ([email protected]) Date received: 14/12/2018 Date accepted: 13/02/2019 Journal of military pharmaco-medicine n o 3-2019 141 Now, laparoscopic resection is used widely in the management of rectal cancer. However, the data on long-term outcomes of rectal cancer are limited. Therefore, the study was conducted with the aim: To evaluate the overall survival and disease-free survival of laparoscopic surgery for rectal cancer. SUBJECTS AND METHODS 1. Subjects. 107 patients with rectal cancer who underwent laparoscopic surgery at Vietduc Hospital from 6 - 2013 to 06 - 2015. * Patient selection criteria: - Patient was diagnosed rectal cancer, that has the distance from lower margin of tumor to the anus margin < 15 cm. - Histopathology diagnosis was rectal cancer and laparoscopic radical surgery for rectal cancer. 2. Methods. - Design study: Prospective, longitudinal comparisons to evaluate the overall survival and disease-free survival of laparoscopic surgery for rectal cancer. - Patients undergoing laparoscopic surgery for rectal cancer. - The overall survival and disease-free survival was calculated using the Kaplan- Meier algorithm. RESULTS Follow-up of 107 rectal cancer patients after laparoscopic surgery with an average duration of 29.3 ± 8.3 months (2 - 47 months), we found the recurrence rate was 15.0%. Mean recurrence time was 26.0 ± 9.8 months (7 - 47 months) and mortality was 9.3%. Table 1: The overall survival and disease-free survival of rectal cancer patients. Overall survival Disease-free survival Time (month) Mortality (n = 10) Rate (%) (X ± SE) Recurrence (n = 16) Rate (%) (X ± SE) 12 2 98.1 ± 1.3 2 98.1 ± 1.3 24 5 94.9 ± 2.2 6 93.8 ± 2.4 36 10 83.7 ± 5.5 15 76.9 ± 6.0 47 - - 16 - X ± SE (95%CI) 43.8 ± 0.9 (42.0 - 45.7) 42.5 ± 1.0 (40.3 - 44.6) - The overall survival of 12, 24 and 36 months were 98.1%. 94.9% and 83.7%, respectively. The overall survival time was 43.8 ± 0.9 months. - The disease-free survival of 12, 24 and 36 months were 98.1%; 93.8% and 76.9%, respectively. The disease-free survival time was 42.5 ± 1.0 months. Journal of military pharmaco-medicine n o 3-2019 142 Chart 1: The overall survival of rectal cancer patients. Chart 2: The disease-free survival of rectal cancer patients. Journal of military pharmaco-medicine n o 3-2019 143 DISCUSSION To evaluate the outcome of cancer surgery, the postoperative survival time should be assessed. The overall survival and disease-free survival of rectal cancer patients were longer or shorter depends on the stage of the disease, the tumor's tissue characteristics, and supportive treatments [3, 4, 5, 6, 7, 8]. Huang C et al (2015) analyzed 492 rectal cancer patients who underwent the laparoscopic surgery and 424 cases in open surgery. Overall survival rate of open surgery and laparoscopic surgery for 1, 3 and 5 years were 94.0% and 93.6% (p = 0.534), 78.1% and 80.9% (p = 0.284) and 75.2% and 77.0% (p = 0.416), respectively. Laparoscopy as an operation for rectal cancer was safe, produced better immediate outcomes. Long-term survival of laparoscopy revealed that it was similar to the open operation [9]. Yang Z.F et al (2018) studied 211 pT4 colorectal cancer patients, including 101 cases in the laparoscopy group and 110 cases in the open surgery group [including 15 cases (12.9%) of conversion to open surgery]. The 3-and 5-year overall survival rates were 74.9% and 60.5%, respectively for the laparoscopy group and 62.4% and 46.5%, respectively, for the open group (p = 0.060). The 3-and 5-year disease-free survival rates were 68.0% and 57.3%, respectively, for the laparoscopy group were and 55.8% and 39.8%, respectively, for the open group (p = 0.053) [0]. We monitored 107 rectal cancer patients with a duration of 29.8 ± 8.5 months (1 - 47 months). The overall survival of 12, 24 and 36 months were 98.1%, 94.9% and 83.7%, respectively. The overall survival time was 43.8 ± 0.9 months. The disease-free survival of 12, 24 and 36 months were 98.1%; 93.8% and 76.9%, respectively. The disease-free survival time was 42.5 ± 1.0 months. This result was similar to some other studies’ (table 2). Table 2: Overall survival compared with some studies. Author Surgery n Overall survival time (month) LAR 82.7 months Green B.L (2013) [8] (62.9 months: 22.9 - 92.8) OP 794 78.3 months (p = 0.78) LAR 492 3 years: 78.1% Huang C et al (2015) [9] MM 424 3 years: 80.9% Trinh Viet Thong (2008) [7] LAR 78 22.6 months Mai Duc Hung (2012) [5] LAR 138 51.0 months (3 years: 79.7%) Le Manh Ha (2013) [4] LAR 106 2 years: 83.9% Nguyen Minh An (2013) [1] LAR 92 68.7 ± 4.7 months Pham Van Binh (2013) [2] LAR 135 33.3 months (3 years: 73.33%) Tran Anh Cuong (2017) [3] OP 105 48.9 ± 0.9 (3 years: 91.7%) Truong Vinh Quy (2018) [6] LAR 52 52.7 ± 3.9 months Research results (2018) LAR 118 43.8 ± 0.9 (3 years: 83.7%) (LAP: Laparoscopic surgery; OP: Open surgery) Journal of military pharmaco-medicine n o 3-2019 144 CONCLUSION Follow-up of 107 rectal cancer patients after laparoscopic surgery with an average duration of 29.3 ± 8.3 months (2 - 47 months), we found that recurrence rate of 15.0% with recurrence time was 26.0 ± 9.8 months. The mortality rate was 9.3%. The overall survival and disease-free survival of 12, 24 and 36 months were 98.1% and 98.1%; 94.9% and 93.8%; 83.7% and 76.9%, respectively. The overall survival and disease-free survival time was 43.8 ± 0.9 months and 42.5 ± 1.0 months. REFERENCES 1. Nguyen Minh An. Research to indication and evaluate the results of laparoscopic surgery for low-rectal cancer. PhD Thesis in Medicine. Military Medical University. 2013. 2. Pham Van Binh. Research on application of laparoscopic surgery for amputation of the rectum treatment for low rectal cancer. PhD Thesis in Medicine. Military Medical University. 2013. 3. Tran Anh Cuong. Study on the features of lymph node metastasis and results of rectal cancer surgery at K Hospital. PhD thesis in Medicine. Hanoi Medical University. 2017. 4. Le Manh Ha, Le Quoc Phong. The outcomes of laparoscopic low anterior resection in rectal cancer. Journal of Practical Medicine. 2013, 5 (870), pp. 133-136. 5. Mai Duc Hung. 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