The Impact of Postoperative Complications on Long-term Oncologic Outcomes After Laparoscopic Low Anterior Resection for Rectal Cancer

Laparoscopic rectal cancer surgery has technical difficulties with a higher complication rate than colon cancer. However, few studies have examined whether postoperative complications are associated with oncologic outcomes. The aim of this study is to evaluate the impact of postoperative complications on long-term oncologic outcomes after laparoscopic low anterior resection for rectal cancer. Between January 2005 and December 2012, we evaluated 686 consecutive patients who underwent laparoscopic low anterior resection for stage I-III rectal cancer. Patients were divided into complication (n = 175) and noncomplication (n = 511) groups. The median follow-up period was 38 months (range, 2–118). We compared perioperative clinicopathologic outcomes, 5-year survival, and local recurrence between groups and evaluated prognostic factors. Five-year overall survival rates were 91.4% and 89.2% (P = 0.234) and 5-year disease-free survival rates were 83.2% and 77.7% (P = 0.002) in the noncomplication and complication groups for all stages, respectively. For stage I cancer, both the 5-year overall survival and the 5-year disease-free survival rate of the complication group were lower than the noncomplication group. Local recurrence rates were 3.1% and 7.8% in the noncomplication and complication groups, respectively (P = 0.002). In multivariate analysis, the presence of postoperative complications was a significant predictor of 5-year disease-free survival (hazard ratio, 1.65; P = 0.012). Postoperative complications had a negative impact on 5-year disease-free survival after laparoscopic low anterior resection for rectal cancer. The rate of local recurrence in the complication group increased more than the noncomplication group. In particular, postoperative complications were associated with poorer oncologic outcomes for stage I cancer. Laparoscopic surgery is preferred for early-stage rectal cancer so careful attention should be paid to avoid postoperative complications.