Current status of laparoscopic surgery for rectal carcinoma – our experience


Authors: L. Martínek;  J. Dostalík;  P. Guňková;  I. Guňka;  P. Vávra
Authors‘ workplace: Chirurgická klinika Fakultní nemocnice Ostrava ;  Přednosta: doc. MUDr. Jan Dostalík, CSc.
Published in: Prakt. Lék. 2009; 89(11): 628-632
Category: In diferent

Overview

Aim:
Objective assessment of laparoscopic surgical technique in the therapy of rectal carcinoma.

Material and methods:
The study included a set of 196 patients who underwent elective surgery for rectal cancer using either laparoscopic or open techniques at the Department of Surgery, University Hospital Ostrava from the 1st of January 2001, to the 31st of December 2006. It was a unicentric, comparative, non-randomized prospective clinical study. The main objective was to compare both short-term results (represented by morbidity and mortality) and long-term results (represented by five-year overall survival).

Results:
Of the postoperative complications, except for a lower incidence of neurological complications in the laparoscopic group ( p = 0,0367), there was no difference in frequency of surgical and non-surgical complications. No difference was shown in morbidity (43 % open group vs. 39 % laparoscopic group), mortality (4 % in both open and laparoscopic groups). Overall five-year survival with open and laparoscopic surgery for all patients was 46 % and 55 % respectively, curative operations 60 % and 75 % respectively, stage I 88 % and 86 % respectively, stage II 87 % and 83 % respectively, stage III 41 % vs. 72 %, stage IV 0 % in both groups.

Except for significantly better five-year overall survival in the group of patients with laparoscopic technique and stage III (p = 0.0381), we reported no difference in long-term overall survival with the surgical techniques being compared.

The same results, i.e. no difference in long-term overall survival, with significantly better long-term overall survival in the laparoscopic group of patients and stage III (p = 0.01677), were obtained by analysis of cumulative survival curves.

Conclusions:
Laparoscopic surgery of rectal carcinoma has the potential for improving the short-term results without discrediting long-term oncological results.

Key words:
rectal cancer, laparoscopy, outcomes.


Sources

1. Agha, A., Fürst, A., Hierl, J. et al. Laparoscopic surgery for rectal cancer: oncological results and clinical outcome of 225 patients. Surg. Endosc. 2008, 22, p. 2229-2237.

2. Anderson, C., Uman, G., Pigazzi, A. Oncologic outcomes of laparoscopic surgery for rectal cancer: a systematic review and meta-analysis of the literature. Eur. J. Surg. Oncol. 2008, 34, p.1135-1142.

3. Aziz, O., Constantinides, V., Tekkis, P.P. et al. Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann. Surg. Oncol. 2006, 13, p. 413-424.

4. Bianchi, P.P., Rosati, R., Bona, S., et al. Laparoscopic surgery in rectal cancer: a prospective analysis of patient survival and outcomes. Dis. Colon Rectum 2007, 50, p. 2047-2053.

5. Braga, M., Frasson, M., Vignali, A. et al. Laparoscopic resection in rectal cancer patients: outcome and cost-benefit analysis. Dis. Colon Rectum 2007, 50, p. 464-471.

6. Bretagnol, F., Lelong, B., Laurent, C. et al. The oncological safety of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma. Surg. Endosc. 2005, 19, p. 892-896.

7. Breukink, S., Pierie, J., Wiggers, T. Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst. Rev. 2006, 4., Art. No: CD005200.

DOI: 10.1002/14651858.CD 005200.pub2.

8. CANCER Mondial: GLOBOCAN 2002 database: summary table by cancer [on line]. [cit.2009-10-05]. Dostupný z WWW: < http://www-dep.iarc.fr/GLOBOCAN/Table2.asp?cancer=60®ion=99&sex=1&sort=2&submit=Execute>.

9. Feliciotti, F., Guerrieri, M., Paganini, A.K. et al. Long-term results of laparoscopic vs open resections for rectal cancer for 124 unselected patiens. Surg. Endosc. 2003, 17, p. 1530-1535.

10. Gao, F., Cao, Y.F., Chen, L.S. Meta-analysis of short term outcomes after laparoscopic resection for rectal cancer. Int. J. Colorectal. Dis. 2006, 21, p. 652-656.

11. Jayne, D.G., Guillou, P.J., Thorpe, H., et al. Randomised trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC trial group. J. Clin. Oncol. 2007, 25, p. 3061-3068.

12. Law, L.W., Lee, Y.M., Choi, H.K. et al. Laparoscopic and open anterior resection for upper and mid rectal cancer: an evaluation of outcomes. Dis. Colon Rectum 2006, 49, p. 1108-1115.

13. Leung, K.L., Kwok, S.P.Y., Lam, S.C.V. et al. Laparoscopic resection of rectosigmoid carcinoma: prospective randomized trial. Lancet 2004, 363, p. 1187-1192.

14. Morino, M., Allaix, M.E., Giraudo, G. et al. Laparoscopic versus open surgery for extraperitoneal rectal cancer: a prospective comparative study. Surg. Endosc. 2005, 19, p. 1460-1467.

15. Ng, S.S., Leung, K.L., Lee, J.F. et al. Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized study. Ann. Surg. Oncol. 2008, 15, p. 2418-2425.

16. Ptok, H., Steinert, R., Meyer, F. et al. Operative Behandlung von Rektumkarzinomen im Vergleich. Chirurg 2006, 77, s. 709-717.

17. Schwandner, O., Schiedeck, T.H.K., Killaitis, C., Bruch, H.P. A case-control-study comparing laparoscopic versus open surgery for rectosigmoidal and rectal cancer. Int. J. Colorectal. Dis. 1999, 14, p.158-163.

18. Staudacher, C., Vignali, A., Saverio, P., et al. Laparoscopic vs. open total mesorectal excision in unselected patients with rectal cancer: impact on early outcome. Dis. Colon Rectum 2007, 50, p. 1324-1331.

19. ÚZIS ČR: Novotvary 2006 [on line] [cit. 2009-10-05]. Dostupný z WWW: < http://www. uzis.cz/download.php?ctg=10&search_name=novotvary®ion=100&kind=1&mnu_id=5300>.

20. Zhou, Z., Hu, M., Li, Y. et al. Laparoscopic versus open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg. Endosc. 2004; 18: p. 1211-1215.

Labels
General practitioner for children and adolescents General practitioner for adults
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account