Results after surgical treatment of rectal cancer in Norway

Abstract

Colorectal cancer is the third most common cancer worldwide, and rectal carcinoma represents about 25% of the cases. Surgical removal of the tumor is the standard curative treatment, and during the last decades the survival rates have improved through both better surgical methods and the introduction of radiochemotherapy. There is, however, still an ongoing debate on which treatment offers the best outcomes for the patients regarding survival, disease recurrence and complications following the treatment. In this study we used patient data from two large national quality registries the Colorectal Cancer Registry and the Norwegian Registry of Gastrointestinal Surgery (NORGAST), to compare results after different surgical techniques for rectal cancer. In total, 1796 patients were enrolled. We found that 5-year overall survival rates for patients without distant metastasis following laparoscopic surgery is equal compared to open surgery (80,0 and 83,0% respectively), and 5-year disease recurrence rates were equally low following laparoscopic surgery as compared to open surgery (3,1 and 4,1% respectively). We also found that conversion to open surgery occurred in 2,1% in robotic assisted laparoscopic procedures compared to 9,6% in standard laparoscopic procedures. Conversion to open surgery was associated with higher rates of complications and inferior results regarding resection margins to tumor. We also found that patients that received a temporary stoma had lower risk of reoperations due to leak from the bowel connection made after removing the tumor, but they experienced other complications that needed reoperation. Patients with and without temporary covering stoma were reoperated to the same extent within the first month after the cancer operation. Temporary stomas did not protect against early reoperations, and did not reduce morbidity or mortality following rectal cancer surgery.