Introduction Over the last decade, minimally invasive modalities have been adopted for the management of colorectal cancers. The COREAN and the MRC-CLASICC trial have established the benefits of laparoscopic surgery in rectal cancers in terms of decreased postoperative pain, shortened hospital stay and speedy recovery. A rapid post operative recovery is essential for initiation of adjuvant chemotherapy especially in stage II-III rectal cancers. The aim of this study was to evaluate whether the type of surgery (Laparoscopic or Open) had any bearing on the time to initiation of adjuvant chemotherapy (TIAC) after complete radical surgical proctectomy.
Method A subset of 181 consecutive patients of operable rectal cancer, who underwent curative resection (laparoscopic or open) and who received postoperative adjuvant chemotherapy between July 2013 and Dec 2014 at the Tata memorial Centre, were studied. The time of initiation of adjuvant chemotherapy (TIAC) after curative resection of rectal cancers and the factors determining the same were studied in an univariate as well as a multivariate analysis. The factors that were analysed were type of surgery (Laparoscopic or open), age, gender, presence of complications and BMI.
Results Fivety seven patients underwent laparoscopic and 124 patients underwent open resection of rectal tumours. 88.4% of the tumours were cT3+ and 61.3% of the tumours were N+ at initial staging. Overall, 90.6% of patients received neoadjuvant chemoradiotherapy prior to surgical resection. After surgery, 6–8 cycles of Single agent Capacetabine (CAP)(8.3%) or Capacetabine with Oxaliplatin (CAPEOX)(91.7%) were the chemotherapeutic agents administered. The median duration of hospital stay was (7.17days vs 10.64 days; p = 0.89) in the laparoscopic and open groups respectively. Overall complications were seen in 17.6% (32/181) of patients, eight in the laparoscopic arm and 24 in the open groups. The median time to start adjuvant chemotherapy after surgery was (21.6days vs. 23.73days; p = 0.94) in the laparoscopic and open groups respectively nor did it influence the duration of postoperative hospital stay. The presence of a surgical complication, however, was associated with a longer TIAC (p = 0.001). On univariate and multivariate analysis, the type of surgery (p = 0.398) did not influence the time of initiation of adjuvant chemotherapy. The only factor that influenced the TIAC was the presence of post operative complications (p = 0.001).
Conclusion To conclude, while laparoscopic surgery has its benefits of shorter hospital stay, fewer complications, our study shows that laparoscopic surgery does not lead to an earlier start of adjuvant chemotherapy.
Disclosure of interest None Declared.
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