José M Quintana1,2, Ane Anton-Ladislao3,4, Santiago Lázaro4,5, Nerea Gonzalez3,4, Marisa Bare4,6, Nerea Fernandez de Larrea7,8, Maximino Redondo4,9, Eduardo Briones10, Antonio Escobar4,11, Cristina Sarasqueta4,12, Susana Garcia-Gutierrez3,4. 1. Unidad de Investigación, Hospital Galdakao-Usansolo, Barrio Labeaga s/n, 48960, Galdakao, Biscay, Spain. josemaria.quintanalopez@osakidetza.eus. 2. Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Madrid, Spain. josemaria.quintanalopez@osakidetza.eus. 3. Unidad de Investigación, Hospital Galdakao-Usansolo, Barrio Labeaga s/n, 48960, Galdakao, Biscay, Spain. 4. Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Madrid, Spain. 5. Servicio de Cirugía General, Hospital Galdakao-Usansolo, Galdakao, Biscay, Spain. 6. Unidad de Epidemiología Clínica, Corporacio Parc Tauli, Barcelona, Spain. 7. Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain. 8. CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. 9. Unidad de Investigación, Hospital Costa del Sol, Malaga, Spain. 10. UDG Salud Publica, Distrito AP Sevilla, Sevilla, Spain. 11. Unidad de Investigación, Hospital Basurto, Bilbao, Biscay, Spain. 12. Unidad de Investigación, Hospital Donostia/Biodonostia, Donostia, Gipuzkoa, Spain.
Abstract
PURPOSE: The goal of this study was to compare the effectiveness of laparoscopic with that of open surgery up to 2 years after intervention in patients with rectal cancer. METHODS: This is a prospective cohort study of patients with rectal cancer who underwent surgery (laparoscopic or open) between June 2010 and December 2012 in 22 acute hospitals. Main outcomes were mortality, complications, reoperation, readmission, and patient-reported outcome measures (PROMs), as measured using the EuroQol-5D (EQ-5D), European Organisation for Research and Treatment of Cancer (EORTC) QLQ-Q30 and Q29, the Barthel Index (BI), and the Duke-UNC Functional Social Support Questionnaire at baseline, 1 year, and 2 years after surgery. Multivariable multilevel logistic regression and generalized linear models were used in the analyses after adjusting for specific propensity scores developed for each outcome and time point. RESULTS: In the multivariable analysis, rates of some medical complications after surgery during admission (renal failure and paralytic ileus) and infectious (urinary tract infection, septic shock, and localized intra-abdominal infection) and at 1 year (renal and heart failure) were higher among patients who underwent open surgery than among those who underwent laparoscopic surgery. There were no differences between the two surgical approaches in all other parameters assessed at the different time points or in all PROMs evaluated. CONCLUSIONS: Laparoscopic surgery and open surgery provide quite similar results in patients with rectal cancer up to 2 years after intervention in most outcomes, though the rates of certain medical and infectious complications at admission and up to 1 year after the intervention were higher in open surgery.
PURPOSE: The goal of this study was to compare the effectiveness of laparoscopic with that of open surgery up to 2 years after intervention in patients with rectal cancer. METHODS: This is a prospective cohort study of patients with rectal cancer who underwent surgery (laparoscopic or open) between June 2010 and December 2012 in 22 acute hospitals. Main outcomes were mortality, complications, reoperation, readmission, and patient-reported outcome measures (PROMs), as measured using the EuroQol-5D (EQ-5D), European Organisation for Research and Treatment of Cancer (EORTC) QLQ-Q30 and Q29, the Barthel Index (BI), and the Duke-UNC Functional Social Support Questionnaire at baseline, 1 year, and 2 years after surgery. Multivariable multilevel logistic regression and generalized linear models were used in the analyses after adjusting for specific propensity scores developed for each outcome and time point. RESULTS: In the multivariable analysis, rates of some medical complications after surgery during admission (renal failure and paralytic ileus) and infectious (urinary tract infection, septic shock, and localized intra-abdominal infection) and at 1 year (renal and heart failure) were higher among patients who underwent open surgery than among those who underwent laparoscopic surgery. There were no differences between the two surgical approaches in all other parameters assessed at the different time points or in all PROMs evaluated. CONCLUSIONS: Laparoscopic surgery and open surgery provide quite similar results in patients with rectal cancer up to 2 years after intervention in most outcomes, though the rates of certain medical and infectious complications at admission and up to 1 year after the intervention were higher in open surgery.
Entities:
Keywords:
Laparoscopy; Open surgery; Outcomes; Prospective cohort; Rectal cancer
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