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Time to Initiation of Postoperative Chemotherapy: An Outcome Measure for Patients Undergoing Laparoscopic Resection for Rectal Cancer

Strouch, Matthew J. M.D.; Zhou, Gongfu Ph.D.; Fleshman, James W. M.D.; Birnbaum, Elisa H. M.D.; Hunt, Steven R. M.D.; Mutch, Matthew G. M.D.

Diseases of the Colon & Rectum: August 2013 - Volume 56 - Issue 8 - p 945–951
doi: 10.1097/DCR.0b013e318290ce30
Original Contributions: Colorectal/Anal Neoplasia

BACKGROUND: Laparoscopic rectal cancer surgery has limited short-term benefits in comparison with open surgery. Long-term measures of recovery are needed.

OBJECTIVE: The aim of this study was to assess the impact of surgical approach (laparoscopic vs open) for the treatment of rectal cancer on the time to postoperative chemotherapy.

DESIGN: This study is a retrospective review of 150 patients who underwent low anterior resection and received postoperative chemotherapy between 2005 and 2011.

SETTINGS: This study was conducted at a tertiary care hospital.

PATIENTS: One hundred fifty patients who had stage II or III rectal cancer who underwent low anterior resection were selected. All patients received postoperative chemotherapy, the timing of which was at the discretion of the oncologist.

MAIN OUTCOME MEASURES: Patient demographics, clinicopathologic variables, and time to postoperative chemotherapy were compared. Multivariate analysis was performed to identify variables affecting the time to postoperative chemotherapy.

RESULTS: There were no differences in clinicopathologic variables between cohorts including age, BMI, sex, ASA score, diverting ileostomy, preoperative radiotherapy, or pathologic stage. Univariate analysis demonstrated differences in intraoperative blood loss (300 vs 448 mL, p < 0.01), length of stay (7.6 vs 8.9 days, p < 0.05), wound infection (12.0 vs 24.0%, p < 0.05), and tumor location (8.0 vs 6.9 cm, p < 0.05) for laparoscopic vs open patients. There were more complications in the open vs laparoscopic group (47 vs 24, p < 0.001); however, the percentage of patients experiencing complications in the open vs laparoscopic cohorts did not reach statistical significance (32.0 vs 18.7%, p = 0.09). A decrease in mean time to postoperative chemotherapy was found for patients undergoing laparoscopic vs open surgery (50.1 vs 75.2 days, p < 0.0001). Multivariate analysis demonstrated that the approach of surgery was an independent predictor of time to postoperative chemotherapy (p < 0.01).

LIMITATIONS: This study was limited by its retrospective design and selection bias.

CONCLUSIONS: In selected patients, patients undergoing laparoscopic rectal cancer surgery receive postoperative chemotherapy 25 days earlier than patients undergoing open surgery. Time to postoperative chemotherapy serves as an outcome measure for improved recovery in laparoscopic rectal cancer surgery.

Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri

Financial Disclosure: None reported.

Correspondence: Matthew G. Mutch, M.D., Section of Colon and Rectal Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8109, St Louis, MO 63110. E-mail:

© 2013 The American Society of Colon and Rectal Surgeons