Effects of Surgical Laparoscopic Experience on the Short-term Postoperative Outcome of Rectal Cancer: Results of a High Volume Single Center Institution (original) (raw)
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Effects of Surgical Laparoscopic Experience on the Short-term Postoperative Outcome of Rectal Cancer
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2010
Purpose: The purpose of the study was to assess the effects of the surgeon's learning curve on the short-term outcome of laparoscopic resections performed for rectal cancer. Methods: A total of 284 patients who underwent laparoscopic resection for rectal cancer performed by 3 different surgical teams between 2005 and 2008 were included in the study. The operative experience was represented by the team's previous surgical case numbers (frequency). Four skill levels were categorized as follows: Level 1: the first 60 cases, Level 2: 61 to 120 cases, Level 3: 121 to 180 cases, and Level 4:>180 cases. Characteristics of the patients, perioperative variables, and the experience levels of the surgeons were analyzed and compared. To investigate the learning curve, we used the following parameters: duration of operative time, conversion rates, general complications, anastomotic leak rates, and oncologic parameters. Results: Operative time gradually decreased with increasing experience. The mean operative times for Level 1, Level 2, and Level 3 were 195.0±46.7, 181.7±34.2, and 172.3±33.0 minutes, respectively, whereas the mean operative time for Level 4 was 151.3±27.7 minutes (P<0.05). With increased experience, conversion rates, complication rates, anastomotic leak rates, and hospitalization durations decreased (P<0.05). The resected specimen length was found to be longer with increased surgical experience (P<0.05). There were no significant differences among the groups with regard to tumor size, T stage, harvested lymph node count, lateral margin involvement, and R0 resections. Conclusions: The operative time is inversely proportional to the level of skill. Laparoscopic surgical procedures do not have any negative effects on short-term surgical outcome. With the strict application of surgical principles, the oncologic quality of the specimen is not influenced by the experience period. With increased experience, the surgeon feels more confident and performs more difficult and complex laparoscopic surgical interventions for rectal cancer.
International Journal of Colorectal Disease, 2006
Objectives The aim of this study was to assess the results of laparoscopic surgery for rectal carcinoma (LSRC) during the learning curve throughout the introduction of this technique at our medical center.Materials and methods From January 2003 to April 2004, 40 patients undergoing surgery were assigned to laparoscopic surgery group (LSG) (n=20) or conventional surgery group (CSG) (n=20). Data were prospectively collected
Longterm and Perioperative Outcomes of Laparoscopic and Open Surgery for Rectal Cancer
SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital, 2018
C olorectal cancers are common worldwide. According to the 2014 Turkish Statistical Institute, it is the fourth most common cancer type in Turkey. The biological structure of colorectal cancers may vary according to their location in the colon. [1] It is recommended that colorectal cancers be examined into two separate groups, as rectum tumors metastasize to the lymph nodes more frequently than colon tumors, and complications, such as anastomosis leakage after rectal surgery, are more frequent. [2, 3] The treatment of rectum cancers has always been challenging. With the use of laparoscopic surgery, the necessity of comparing open surgery with oncologic results arises. In Objectives: The necessity of comparing oncologic results with the use of minimally invasive surgery in rectal cancer has arisen. The aim of the present study was to evaluate the treatment approach in rectal cancer and to compare the outcomes of laparoscopic and open surgery. Methods: Patients who underwent surgery for rectal carcinoma between January 2006 and January 2016 in our institution were evaluated. The results were compared between the two groups according to open or laparoscopic surgery. Clinical characteristics, preoperative and postoperative results, pathological examination results, and disease-free survival rates were compared after the surgical procedure. Results: A total of 121 patients were included in the study. Of the patients, 50 underwent open, and 71 underwent laparoscopic surgery. The median follow-up times were 56.75 months in the open surgery group and 55.2 months in the laparoscopic surgery group. Pathological examination revealed similar numbers of lymph nodes in both groups (p>0.05). The duration of hospital stay was statistically significantly lower in the open surgery group than in the laparoscopic group (p<0.05). The rates of disease-free survival were 74% in the open surgery group and 82.5% in the laparoscopic group, and no statistically significant difference was found (p>0.05). Conclusion: There was no significant difference in complication and recurrence between laparoscopic and open surgery for rectal cancer in our study. The duration of hospital stay of patients was statistically significantly lower in the laparoscopic group than in the open surgery group. Laparoscopic or open surgical options could be preferred according to the clinical suitability of the patient, experience of the surgeon, and resources of the center in rectal cancer treatment.
Laparoscopic surgery for rectal cancer: a single-centre experience of 120 cases
International Journal of Colorectal Disease, 2011
Introduction For colorectal surgeons, laparoscopic rectal cancer surgery poses a new challenge. The defence of the questionable oncological safety tempered by the impracticality of the long learning curve is rapidly fading. As a unit specialising in minimally invasive surgery, we have routinely undertaken rectal cancer surgery laparoscopically since 2005. Methods Patients undergoing surgery for rectal cancer between June 2005 and February 2010 were retrospectively reviewed from a prospectively maintained colorectal cancer database. Results One hundred and thirty patients underwent surgery for rectal cancer during the study period. One hundred and twenty patients had a laparoscopic resection, six were converted to open (conversion rate 5%) and 10 had a planned primary open procedure. Fifty four were low rectal tumours and 76 were upper rectal tumours. One hundred and thirteen patients had an anterior resection (87%), 17 patients an abdomino-perineal resection (13%) and 62 of the 130 patients (47.6%) had neoadjuvant radiotherapy. The median lymph node retrieval rate was 12 (9-14), five patients (3.8%) had a positive circumferential margin and the clinical anastomotic leak rate was 3.8% (n=5 patients). There was no significant difference in the stated parameters for neoadjuvant versus non-neoadjuvant patients and for upper versus lower rectal tumours. Ninety three percent of mesorectal excision specimens were complete on pathological assessment. Conclusions During the study period, 92% of rectal cancers underwent a laparoscopic resection with low rates of morbidity and acceptable short-term oncological outcomes. This data supports the view that laparoscopic surgery for rectal cancer can be safely delivered in mid-volume centres by surgeons who have completed the learning curve for laparoscopic colorectal surgery.
Critical appraisal of laparoscopicvsopen rectal cancer surgery
World Journal of Gastrointestinal Surgery, 2016
AIM: To evaluate the long-term clinical and oncological outcomes of laparoscopic rectal resection (LRR) and the impact of conversion in patients with rectal cancer. METHODS: An analysis was performed on a prospective database of 633 consecutive patients with rectal cancer who underwent surgical resection. Patients were compared in three groups: Open surgery (OP), laparoscopic surgery, and converted laparoscopic surgery. Short-term outcomes, long-term outcomes, and survival analysis were compared. RESULTS: Among 633 patients studied, 200 patients had successful laparoscopic resections with a conversion rate of 11.1% (25 out of 225). Factors predictive of survival on univariate analysis include the laparoscopic approach (P = 0.016), together with factors such as age, ASA status, stage of disease, tumor grade, presence of perineural invasion and vascular emboli, circumferential resection margin < 2 mm, and postoperative adjuvant chemotherapy. The survival benefit of laparoscopic surgery was no longer significant on multivariate
Laparoscopy in the surgical treatment of rectal cancer in Germany 2000-2009
Colorectal Disease, 2012
Aim The goal of this registry study was to compare open surgery with planned laparoscopy and then with laparoscopic to open conversion for rectal cancer surgery. Method The study included 17 964 rectal cancer patients, operated on between 1 January 2000 and 31 December 2009, from 345 hospitals in Germany. All statistical tests were two-sided, with the v 2 test (Pearson correlation) for patients and tumour characteristics. Fisher's exact test was used for complications and 30-day mortality. Results Of the 17 964 rectal cancer patients, 16 308 (90.8%) had an open procedure and 1656 (9.2%) were started with a laparoscopy. The 1455 patients with completed laparoscopic operations had fewer intra-operative and postoperative complications (5.4% vs 7.0%, P = 0.020, and 20.5% vs 25.8%, P < 0.001, respectively) and a lower 30-day mortality rate (1.1% vs 1.9%, P = 0.023). Of the 1656 planned laparoscopies, 201 (12.1%) were converted to open. The converted group suffered more intra-operative complications (18.9% vs 3.6% for completed laparoscopy and 7.0% for open surgery, P < 0.0001) and postoperative complications (32.3% vs 18.9% for completed laparoscopy and 25.8% for open operations, P < 0.0001). The converted group also had a higher 30-day mortality rate (2.0% vs 1.0% for completed laparoscopy and 1.9% for open surgery, P = 0.043). Conclusion The more favourable patient profile provided justification for a laparoscopic procedure. For those converted to an open procedure, however, there were significantly more complications than planned open surgery patients. A move away from the standard open procedure for rectal cancer surgery and towards laparoscopy is not yet feasible.
Laparoscopic surgery for rectal cancer
The Permanente journal, 2009
Laparoscopic surgery for rectal cancer is much more challenging than that for colon cancer because of the confined space within the pelvis. Further, because of the tumor's location in the pelvis, maintenance of resection margins is of greater concern. Nonrandomized studies by groups experienced in laparoscopic surgery have shown both that it produces short-term outcomes equivalent to those for open surgery and that it can be performed safely from an oncologic perspective. Nonsurgical complications appear to be fewer, but conversion to open surgery may become a real issue. This review summarizes these findings by addressing technical considerations, early outcomes, late outcomes, costs, and complications.
Laparoscopic surgery for the treatment of rectal cancer: short-term results
Chirurgia (Bucharest, Romania : 1990)
The aim of this study was to establish the efficiency, safety and feasibility of laparoscopic surgery for rectal cancer by assessing the short-term outcomes. In this prospective clinical study, from 2008 to 2011, 60 patients with laparoscopic resection for rectal cancer were included, treated in "Prof. Dr. Octavian Fodor" Gastroenterology and Hepatology Institute, Department of Surgery and Surgery Clinic I, Cluj-Napoca. Surgical procedures included 38 abdominal-perineal resections, 21 anterior resections and 1 Hartmann procedure. Average blood loss was 250 ml (100-800 ml) and median length of postoperative hospital stay was 9 days (4-91 days). Blood loss was significantly higher in patients with low rectal cancer than those with upper rectal cancer (300 ml vs 200 ml, p=0.031). Conversion to open surgery was required in 8 patients (13.3%). Overall postoperative complications were 28.8%. Positive circumferential margins occurred in 1 patient (1.7%), while distal margins were...
Clinical Application of Laparoscopy in Radical Operation of Rectal Cancer
Objective: Analyze the clinical value of laparoscopic used in the colorectal cancer surgery. Methods: A total number of 371 clinical cases, from January 2012 to October 2014 in our hospital, were analyzed which covered 198 patients underwent the laparoscopy in radical resection and 173 cases in open radical resection. A retrospective analysis was proceeded by comparing the general information, surgery performance, pathologic data, postoperative recovery and complicetions as well as long-term survival to investigate the diversity of immediate and long-term clinical outcomes of laparoscopic radical operation. Results: All patients have successfully completed the surgery, which includes 198 cases of laparoscopic rectal resection, 173 cases in open radical resection. There were no statistically significance differences between gender, age, height, BMI, staging and associated with other diseases in two groups. The operative time of rectal resection under the Laparoscopic was shorter than open radical resection (120±30minvs 105±39min), with no statistical significance(P＞0.05).In the laparoscopy surgery, the amount of bleeding is less than open surgery (50±20ml VS 200±25ml), and the difference was statistically significant. In the laparoscopy surgery, the length of incision is shorter than open surgery (5.1±0.23cm VS 13.5±1.34cm), and the difference was statistically significant. The hospitalization length in laparoscopy surgery and open surgery was significant difference (P＜0.01). Conclusion: In contrast to open surgery group, the laparoscopy surgery group expericenced less bleeding, shorter incisionand hospitalization length. The incident rate of perioperation complications in laparoscopy surgery and open surgery groups were not significant different. The colorectal cancer resection with laparoscopic has less trauma and can recover quickly, so it can achieve the same radical effect just like laparotomy and worth to be promoted in the Clinical application.