Year: 2015
Type: dissertation
Abstract: Introduction\nColorectal cancer is the third most common cancer worldwide, with nearly 1.4 million new cases annually, of which\nabout one third suffer from rectal cancer. Laparoscopic surgery has in several surgical fields shown faster recovery,\nshorter hospital stay, and less pain than open surgery. In rectal cancer surgery firm evidence is lacking regarding\noncological safety. Moreover, patient-reported Health Related Quality of Life (HRQL) has become an important\noutcome in clinical trials, complementing clinically driven endpoints.\nAim\nThe aim of this thesis was to assess if laparoscopic rectal cancer surgery is non-inferior to open surgery in terms of locoregional\nrecurrence, disease specific and overall survival, as well as to compare the outcome regarding health related\nquality of life and genitourinary dysfunction. We also analysed if there are factors that determine global quality of life.\nPatients and method\nThe four papers were analysed within the only large randomised international multicentre trial comparing laparoscopic\nand open surgery for rectal cancer – the COLOR II trial - an open label non-inferiority trial. Between 2004-2010, 1044\npatients from 30 centres in 8 countries were included. The HRQL sub-study was optional and included 385 patients.\nResults\nIn paper I, the primary outcome in COLOR II showed that laparoscopic surgery was non-inferior to open surgery with a\nloco-regional recurrence rate of 5% in both groups with a difference of 0% (90% CI of -2.6 to 2.6). In paper II and III we\nshowed that there were no differences in HRQL and genitourinary dysfunction between the surgical techniques. In paper\nIV we discovered pain and fatigue as possible important factors of global quality of life.\nConclusion\nThe overall conclusion was that laparoscopic rectal cancer surgery is non inferior to open surgery in rectal cancer in\nterms of oncological safety. Based on earlier results showing benefits of laparoscopic rectal resection, now is the time to\nwidely implement the technique.
Author: John Andersson
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W820337816