Laparoscopic rectal cancer surgery with and without neoadjuvant chemo-irradiation: a comparative study

To evaluate the perioperative short-term outcomes of laparoscopic rectal cancer surgery in patients after neoadjuvant chemo-irradiation. This is a comparative cohort study designed to compare the perioperative and short-term outcomes of laparoscopic rectal cancer surgery in patients with and without neoadjuvant therapy. Patients undergoing elective laparoscopic rectal cancer surgery after neoadjuvant chemo-irradiation formed the study group; those receiving surgery without neoadjuvant therapy and in whom the final histology confirmed either transmural or node-positive diseases were selected as controls. Fifty-two patients in the neoadjuvant group were compared with 138 patients in the control group. Both groups were comparable in terms of American Society of Anesthesiologists (ASA) grading and gender distribution. Median operating time was significantly longer in the neoadjuvant group (155 versus 135 mins, p = 0.09, Mann-Whitney U test). No significant difference was observed in terms of blood loss, conversion rates, postoperative morbidity, length of hospital stay or sphincter preservation rates. Overall 5-year survival rates in the two groups remained similar. Our data confirmed that, aside from a slightly longer operating time, laparoscopic rectal cancer surgery in patients with neoadjuvant chemo-irradiation is safe with no increased morbidity. Based on our experience, patients after neoadjuvant therapy should not be deterred from the minimally invasive approach.