Overall survival and disease free survival of laparoscopic surgery for rectal cancer

Journal of military pharmaco-medicine no3-2019

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 ()

Date received: 14/12/2018
Date accepted: 13/02/2019

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Journal of military pharmaco-medicine no3-2019
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.

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

SUBJECTS AND METHODS

survival was calculated using the Kaplan-

1. Subjects.

Meier algorithm.

107 patients with rectal cancer who
underwent laparoscopic surgery at Vietduc
Hospital from 6 - 2013 to 06 - 2015.

RESULTS

* Patient selection criteria:

Follow-up of 107 rectal cancer patients

- Patient was diagnosed rectal cancer,
that has the distance from lower margin of
tumor to the anus margin < 15 cm.

after laparoscopic surgery with an average
duration of 29.3 ± 8.3 months (2 - 47 months),
we found the recurrence rate was 15.0%.

- Histopathology diagnosis was rectal
cancer and laparoscopic radical surgery
for rectal cancer.

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

Time (month)

Disease-free survival

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.
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Journal of military pharmaco-medicine no3-2019

Chart 1: The overall survival of rectal cancer patients.

Chart 2: The disease-free survival of rectal cancer patients.
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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)

Green B.L (2013) [8] (62.9 months:
22.9 - 92.8)

LAR

794

82.7 months

OP

78.3 months (p = 0.78)

LAR

492

3 years: 78.1%

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%

Huang C et al (2015) [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)
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Journal of military pharmaco-medicine no3-2019
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.
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