Quality of surgery for rectal carcinoma: comparison between open and laparoscopic approaches (original) (raw)
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Surgical Endoscopy, 2005
B ackground: Next to surgical margins, yield of lymph nodes, and length of bowel resected, macroscopic completeness of mesorectal excision may serve as another quality control of total mesorectal excision (TME). In this study, the macroscopic completeness of laparoscopic TME was evaluated. Methods: A series of 25 patients with rectal cancer were managed laparoscopically (LTME) and included in this study. The pathologic specimens of the LTME group were prospectively examined and matched with a historical group of resection specimens from patients who had undergone open TME (OTME). The two groups were matched for gender and type of resection (low anterior or abdominoperineal resection). Special care was given to the macroscopic judgment concerning the completeness of the mesorectum. Results: A three-grade scoring system showed no differences between the LTME and OTME groups. Conclusion: The current study supports the hypothesis that oncologic resection using laparoscopic TME is feasible and adequate.
Laparoscopic vs. open total mesorectal excision for treatment of rectal cancer
2008
INTRODUCTION Because definitive long-term results are not yet available, the oncologic safety of laparoscopic surgery in rectal cancer remains controversial. Laparoscopic total mesorectal excision (LTME) for rectal cancer has been proposed to have several short-term advantages in comparison with open total mesorectal excision (OTME). However, few prospective randomized studies have been performed. OBJECTIVES The main purpose was to evaluate whether there are relevant differences in safety and efficacy after elective LTME for the treatment of rectal cancer compared with OTME in a tertiary academic medical center. MATERIAL AND METHODS This comparative non-randomized prospective study analyzes data of 20 patients with middle and low rectal cancer treated with low anterior resection (LAR) or abdomino perineal resection (APR) from November 2005 to April 2006. Follow-up was determined through office charts or direct patient contact. Statistical analysis was performed using chi2 test and S...
International Journal of Colorectal Disease, 2007
Background The purpose of this study was to present our experience of laparoscopic total mesorectal resection, including ultralow resection and coloanal anastomosis. Materials and methods Between 1993 and 2005, patients fit for general anesthesia, with resectable cancers, and with lower edge of tumor beyond 5 cm of the anal verge were subjected to laparoscopic anterior resection with sphincter preservation. Double stapling technique is used to establish bowel continuity. Results A total of 170 patients, 88 males and 82 females, were subjected to successful laparoscopic anterior resection, which included high anterior resection (n=90), low anterior resection (n=52), ultralow anterior resection (n=20), and coloanal anastomosis (n=8). The average age of patients was 58.4 years (12-90 years). Mean operating time was 130 min and mean hospital stay was 7 days. The morbidity was 13.5% with nil mortality. With an average follow-up of 49 months (range 9 years to 3 months), 9 patients developed local recurrence and 45 patients developed distant metastasis. Conclusion In selected cases, laparoscopic anterior resection is possible for all levels of rectal tumors, allowing sphincter preservation and maintaining oncological safety.
Journal of Surgery, 2016
Total mesorectal excision (TME) has emerged as a method for complete cure of rectal cancer with promising results. The present study aimed to evaluate the technical feasibility and the clinical and oncological outcomes of laparoscopic TME with abdominoperineal resection (APR) for distal rectal carcinoma. Twenty patients with distal rectal carcinoma were treated with laparoscopic APR and TME in the period of January 2012 to March 2015. Patients' demographics, clinical symptoms, operation time, complications, pathological characteristics of the rectal tumor, and the local and distant recurrence of the tumor were recorded and analyzed. The study included 11 (55%) female and 9 (45%) male of a mean age of 46.9 ± 10.8 years. The mean distance of the tumor from the anal verge was 3.35 ± 0.9 cm. The mean operation time was 182 ± 7 minutes. Adenocarcinoma accounted for 55% of cases, whereas mucinous adenocarcinoma was detected in 40% of patients, and signet ring carcinoma in 5%. The mean circumferential resection margin (CRM) was 4.6 ±3.5 mm. The mean duration of hospital stay was 9.21± 6.9 days. Perioperative complications were recorded in seven patients (35%). Five (25%) cases were converted to open surgery. The median follow-up duration was 18 months. Local recurrence was diagnosed in two (10%) cases. Laparoscopic TME is a technically feasible procedure, yet requires adequate training and sufficient knowledge of the anatomy of the pelvis. Although all patients underwent APR and 90% of them received neoadjuvant treatment; the local recurrence was still higher than other studies which can be attributed to the pathologic characters and the stage of the tumors.
Comparison of transanal versus laparoscopic total mesorectal excision in low rectal cancer
Annals of Colorectal Research, 2020
Background: Transanal Total Mesorectal Excision (TaTME) presented in recent years as a novel technique to achieve better outcome in circumferential margin (CRM) and distal margin (DRM) in lower rectal cancer operation. The current study aimed to assess the perioperative and pathological characteristics of TaTME in comparison with laparoscopic total mesorectal excision (LaTME) in patients with mid- and low-rectal cancer. Methods: From January 2016 to December 2018, we enrolled all consecutive patients with rectal cancer, who underwent TaTME and LaTME. Primary endpoints like circumferential rectal margin (CRM) status, distal rectal margin (DRM) status, and pathological outcomes, as well as secondary endpoints including perioperative outcomes (total blood loss, duration of hospitalization, anastomosis leakage, as well as 30-day mortality) were evaluated and compared statistically (α=0.05). Results: 11 patients with distal rectal adenocarcinoma which was biopsy-proven, underwent TaTME, ...
2018
AIM The pathologist's role in the multidisciplinary treatment of rectal cancer is to evaluate and stage the tumor according to the latest standards, as well as indicate the quality of the surgical act. This study aims to evaluate circumferential and distal resection margins as well as quality of mesorectal resection and correlate them with different clinical, pathological and therapeutic factors. PATIENTS, MATERIALS AND METHODS Four hundred ninety-eight patients treated radically for mid and low rectal cancer within one Clinic of Oncological Surgery in Iasi, Romania, were included in this study. RESULTS The distal resection margin showed significant correlations with the type of surgical intervention, chemotherapy in the neoadjuvant treatment plan and pathological node staging. The circumferential resection margin depended mostly on pathological node staging and the length of the interval between neoadjuvant treatment and surgery. Finally, the aspect of the mesorectum varied acc...
Techniques in Coloproctology, 2016
Background Natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopy are spreading worldwide. Total mesorectal excision (TME), the standard treatment for patients with distal rectal tumors, is usually performed in an ''up-to-down'' approach, either laparoscopically (LAP TME) or as an open procedure. We have already reported a NOTES-inspired, transanal, ''down-to-up'' variant of TME (NOTES TME). The main aim of this study was to assess the quality of the resected specimen in patients who had undergone either NOTES TME or LAP TME. Methods All patients with distal rectal neoplasia presenting between January 2011 and December 2014 were considered for the study. Additional inclusion criteria comprised American Society of Anesthesiologists score B III and the absence of previous open surgery. Assignment to either group was sequential and based on the rank of inclusion in the study. The primary endpoint was the macroscopic quality of the specimen. Secondary endpoints included nerve visualization, tumor perforation, operating time, status of margins, and number of retrieved nodes. Results Eighteen patients (6 men, 12 women) were in the NOTES TME group and 15 (7 men, 8 women) in the LAP TME group, respectively. The TME specimen was considered complete or mainly regular in 16 patients who had undergone NOTES TME (88.9 %) and in 11 patients who had undergone LAP TME (73.3 %), (p [ 0.05). During the procedure, we visually identified the neurovascular bundles of Walsh in 14 patients in the NOTES TME group (77.8 %) and in only 5 patients in the LAP TME group (33.3 %), (p \ 0.05). Mean operative time was 245 min (range 155-440 min) in the NOTES TME group and 275 min (range 180-400 min) in the LAP TME group (p [ 0.05). A median of 11 nodes per specimen (range 8-22 nodes) was retrieved in the NOTES TME group and 12 nodes (range 6-41 nodes) in the LAP TME group, respectively (p [ 0.05). Distal and radial margins were comparable in both groups. Conclusions Compared to the LAP TME, the NOTES TME seems to be associated with a more frequent intraoperative identification of the sacral nerves. However, the difference in overall quality of the retrieved specimen, although favoring NOTES TME, did not reach statistical significance in this small series. Keywords Rectum Á Mesorectum Á NOTES Á TAMIS Á taTME Á Transanal TME Á Total mesorectal excision Á Single port Á Rectal cancer Á Laparoscopy On behalf of The Intercontinental Society of Natural Orifice, Endoscopic, and Laparoscopic Surgery (i-NOELS), France.
Surgical Endoscopy, 2005
Background: Although experience of laparoscopic treatment of rectal carcinoma has been reported, there is no evidence of its oncological safety because most procedures included partial mesorectal excision or abdominoperineal excision and quality of surgery is lacking. The aim of this study was to assess the oncological results of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma. Methods: From 2000 to 2003, 144 patients underwent laparoscopic total mesorectal excision with low colorectal or coloanal anastomosis for mid and low rectal adenocarcinoma. There were 88 men and 56 women, with a median age of 65 years. The tumor was located at 5.5 cm (range 1-12) from the anal verge and was classified uT1T2 in 25 cases and uT3 in 119 cases. One hundred twenty patients received preoperative radiotherapy. Results: Postoperative mortality and morbidity were 1% and 34% respectively. Conversion was 14% (n = 20). Macroscopic assessment of the specimen (n = 92) showed an intact mesorectum in 88% of the cases. The distal margin and the circumferential margin were safe in 98% and 94% of the cases, respectively. A complete microscopic excision, i.e., R0 resection, was achieved in 134 cases (93%). Pathological data were similar to those of an open match group. With a median follow-up of 18 months, there was no port-site recurrence and two patients had local recurrence (1.4%). The 3-year overall and disease-free survival rates were 89% and 77%, respectively.
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie, 2016
Worldwide, colorectal cancer is one of the most prevalent malignancies. Due to oncological safety concerns, data regarding the laparoscopic surgical treatment of rectal cancer is scarce. Our study's main aim was investigate the oncological adequacy of laparoscopic surgery in the treatment of rectal cancer by comparing its oncological reliability with the oncological results obtained after open surgery for rectal cancer. In this retrospective study, 80 patients who underwent surgery for rectal cancer, admitted in our Clinic between January 1, 2014-November 31, 2015 were enrolled. The studied group was stratified according to the way of approach chosen: classic surgery (59 cases) and laparoscopic surgery (21 cases), respectively. Based on the histopathological examination, we analyzed the histological grading of rectal neoplasms, TNM staging, resection margins, lymphovascular and perineural invasion and the number of regional lymph nodes identified in the perirectal adipose tissue...