A propensity‐score‐matched analysis of laparoscopic <i>vs</i> open surgery for rectal cancer in a population‐based study

  • P. Manchon‐Walsh
    Catalonian Cancer Strategy Department of Health Government of Catalonia Barcelona Spain
  • L. Aliste
    Catalonian Cancer Strategy Department of Health Government of Catalonia Barcelona Spain
  • S. Biondo
    Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona Barcelona Spain
  • E. Espin
    Colorectal Surgery Unit Vall d'Hebron University Hospital Barcelona Spain
  • M. Pera
    Colorectal Surgery Unit Department of Surgery Hospital del Mar (IMIM) Barcelona Spain
  • E. Targarona
    Colorectal Surgery Unit Hospital de la Santa Creu i Sant Pau Barcelona Spain
  • N. Pallarès
    Statistics Advisory Service Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona Barcelona Spain
  • R. Vernet
    Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona Barcelona Spain
  • J. A. Espinàs
    Catalonian Cancer Strategy Department of Health Government of Catalonia Barcelona Spain
  • A. Guarga
    Health Service Procurement and Assessment Catalonian Health Service (CatSalut) Barcelona Spain
  • J. M. Borràs
    Catalonian Cancer Strategy Department of Health Government of Catalonia Barcelona Spain

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<jats:title>Abstract</jats:title><jats:sec><jats:title>Aim</jats:title><jats:p>The oncological risk/benefit trade‐off for laparoscopy in rectal cancer is controversial. Our aim was to compare laparoscopic <jats:italic>vs</jats:italic> open surgery for resection of rectal cancer, using unselected data from the public healthcare system of Catalonia (Spain).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This was a multicentre retrospective cohort study of all patients who had surgery with curative intent for primary rectal cancer at Catalonian public hospitals from 2011 to 2012. We obtained follow‐up data for up to 5 years. To minimize the differences between the two groups, we performed propensity score matching on baseline patient characteristics. We used multivariate Cox proportional hazards regression analyses to assess locoregional relapse at 2 years and death at 2 and 5 years.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of 1513 patients with Stage I–III rectal cancer, 933 (61.7%) had laparoscopy (conversion rate 13.2%). After applying our propensity score matching strategy (2:1), 842 laparoscopy patients were matched to 517 open surgery patients. Multivariate Cox analysis of death at 2 years [hazard ratio (HR) 0.65, 95% CI 0.48, 0.87; <jats:italic>P</jats:italic> = 0.004] and 5 years (HR 0.61, 95% CI 0.5, 0.75; <jats:italic>P</jats:italic> < 0.001) and of local relapse at 2 years (HR 0.44, 95% CI 0.27, 0.72; <jats:italic>P</jats:italic> = 0.001) showed laparoscopy to be an independent protective factor compared with open surgery.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Laparoscopy results in lower locoregional relapse and long‐term mortality in rectal cancer in unselected patients with all‐risk groups included. Studies using long‐term follow‐up of cohorts and unselected data can provide information on clinically relevant outcomes to supplement randomized controlled trials.</jats:p></jats:sec>

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