Factors Influenceing the Oncologic Results after Abdominoperineal Resection: Does the Introduction of Laparoscopic Procedures Influence the Oncologic Results?

ABSTRACT

PURPOSE: Although indications for abdominoperineal resection (APR) are decreasing due to the widespread of sphincter-saving procedures, APR is still the mainstay in the treatment of rectal cancer. The purpose of this study is to demonstrate the appropriateness of laparoscopic APR in terms of oncologic parameters. METHODS: From January 1984 to December 2003, 110 patients with a rectal adenocarcinoma who underwent APR were involved in this study. The data were grouped according to five main items 1) patient demographic data, 2) operative procedure, 3) gross tumor findings, 4) pathologic tumor findings, and 5) perioperative treatment. Each item was subdivided by factors that could influence the oncologic results, and univariate analyses were performed. Thereafter, a multivariate analysis was performed with those factors considered statistically significant. RESULTS: The mean follow-up period was 106.01+/-9.98 months, the local recurrence rate was 23.6%, and distant metastasis rate was 31.8%. The five-year survival rate was 58.1%, and the ten-year survival rate was 51.1%. Multivariate analysis after univariate analyses showed that independent prognostic factors influencing local recurrence were preoperative CEA level, T-stage, and preoperative radiation therapy. Factors influencing distant metastasis were preoperative CEA level, N-stage, and preoperative radiation therapy. Univariate analysis showed that the laparoscopic approach was beneficial in terms of local recurrence; however, with the multivariate analysis, this was not statistically evident. Prognostic factors influencing long-term survival in the multivariate analysis were preoperative CEA level, stage, and perineural invasion. CONCLUSIONS: Laparoscopic APR was not significantly different from an open procedure in terms of oncologic outcomes. In the near future, a randomized prospective multicenter trial should tell us which approach is more beneficial.