Reconsideration of the oncologic safety of laparoscopic rectal cancer surgery (original) (raw)
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Reconsideration of the Safety of Laparoscopic Rectal Surgery for Cancer
Annals of Coloproctology, 2019
The oncological outcomes of laparoscopic rectal cancer surgery were evaluated in recent multicenter randomized clinical trials (RCTs). The MRC-CLASSIC, COLOR II, and COREAN trials found no differences in local recurrence or diseasefree survival rate between laparoscopic and open surgery. However, the noninferiority of laparoscopic surgery with respect to open surgery for rectal cancer was not established on statistical analysis in the ACOSOG Z6051 and the ALaC-aRT trials. Quality of total mesorectal excision (TME) is one of the most important prognostic factors. Incomplete TME had unfavorable oncologic outcomes compared to complete TME. Although TME quality can be clearly identified on pathologic evaluation, there is controversy regarding the acceptable range of oncologically safe TME for laparoscopic surgery. It is not certain whether near-complete TME has an unfavorable oncologic impact and whether laparoscopic surgery with near-complete TME is an oncological threat. Therefore, the surgical community will be interested in the long-term outcomes and meta-analyses of ongoing large-scale RCTs. Laparoscopic rectal cancer surgery has been steadily improving its safety for oncology surgery, which has been reported consistently in various multicenter RCTs. To improve surgical quality, colorectal surgeons should choose the most appropriate surgical technique, including laparoscopic surgery.
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...
The Lancet Oncology, 2013
Methods A non-inferiority phase 3 trial was undertaken at 30 centres and hospitals in eight countries. Patients (aged ≥18 years) with rectal cancer within 15 cm from the anal verge without evidence of distant metastases were randomly assigned to either laparoscopic or open surgery in a 2:1 ratio, stratifi ed by centre, location of tumour, and preoperative radiotherapy. The study was not masked. Secondary (short-term) outcomes-including operative fi ndings, complications, mortality, and results at pathological examination-are reported here. Analysis was by modifi ed intention to treat, excluding those patients with post-randomisation exclusion criteria and for whom data were not available. This study is registered with ClinicalTrials.gov, number NCT00297791.
Laparoscopic Surgery Compared to Open Surgery in Excision of Rectal Cancer : A Systematic Review
The Egyptian Journal of Hospital Medicine, 2018
Background: The laparoscopic surgery for rectal cancer, such as open surgery, is associated with many surgical complications, especially if the surgeon does not have sufficient experience in open total mesorectal excision and advanced laparoscopic surgery. This review aiming at comparing the effectiveness and the complications rate of laparoscopic surgery to those of open surgery. Methods: The comprehensive electronic search was conducted in Medline and Embase databases. The search resulted in 102 relevant clinical trials, which were subjected to primary screening and exclusion of ineligible studies. Finally, 32 potentially relevant clinical trials were included in the secondary screening from which nine clinical trials were included in this review. Data were collected from included studies using data extraction forms, then the qualitative synthesis of extracted data was conducted. Results: Small differences between interventions were reported by the included studies. Five-years survival rates tend to be slightly higher in the open surgery, whereas 3-years survival rates were higher in the laparoscopic surgery. It be attributed to the wider safe margin for tumor excision obtained in open surgery. The complications rates were slightly lower in the laparoscopy groups among most of the included studies. Conclusions: This review found comparable outcomes of laparoscopy and open surgery in treatment of rectal cancer with minimal differences in survival and complications rates.
PLOS ONE, 2020
Background To analyze pathologic and perioperative outcomes of laparoscopic vs. open resections for rectal cancer performed over the last 10 years. Methods A systematic literature search of the following databases was conducted: Cochrane Central Register of Controlled Trials, MEDLINE (through PubMed), EMBASE, and Scopus. Only articles published in English from January 1, 2008 to December 31, 2018 (i.e. the last 10 years), which met inclusion criteria were considered. The review only included articles which compared Laparoscopic rectal resection (LRR) and Open Rectal Resection (ORR) for rectal cancer and reported at least one of the outcomes of interest. The analyses followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement checklist. Only prospective randomized studies were considered. The body of evidence emerging from this study was evaluated using the Grading of Recommendations Assessment Development and Evaluation (GRADE) system. Outcome measures (mean and median values, standard deviations, and interquartile ranges) were extracted for each surgical treatment. Pooled estimates of the mean differences were calculated using random effects models to consider potential inter-study heterogeneity and to adopt a more conservative approach. The pooled effect was considered significant if p <0.05.
2014
Background This review of cancer outcomes is based on key literature searches of the medical databases and metaanalysis of short-term benefits of laparoscopy in rectal cancer treatment. Methods We carried out a systematic review of randomized clinical trials (RCTs) and prospective non-randomized controlled trials (non-RCTs) published between January 2000 and September 2013 listed in the MEDLINE and EMBASE databases (PROSPERO Registration number: CRD42013005076). The primary endpoint was clearance of the circumferential resection margin. Meta-analysis was performed using a fixed-effect model, and sensitivity analysis by a random-effect model; subgroup analysis was performed on subsets of patients with extraperitoneal cancer of the rectum. Relative risk (RR) and mean difference (MD) were used as outcome measures. Results Twenty-seven studies (10,861 patients) met the inclusion criteria; eight were RCTs (2,659 patients). The RCTs reported involvement of the circumferential margin in 7.9 % of patients who underwent laparoscopic and in 6.9 % of those undergoing open surgery; the overall RR was 1.00 (95 % confidence interval 0.73-1.35) with no heterogeneity.
A randomized trial of laparoscopic versus open surgery for rectal cancer
The New England journal of medicine, 2015
Laparoscopic resection of colorectal cancer is widely used. However, robust evidence to conclude that laparoscopic surgery and open surgery have similar outcomes in rectal cancer is lacking. A trial was designed to compare 3-year rates of cancer recurrence in the pelvic or perineal area (locoregional recurrence) and survival after laparoscopic and open resection of rectal cancer. In this international trial conducted in 30 hospitals, we randomly assigned patients with a solitary adenocarcinoma of the rectum within 15 cm of the anal verge, not invading adjacent tissues, and without distant metastases to undergo either laparoscopic or open surgery in a 2:1 ratio. The primary end point was locoregional recurrence 3 years after the index surgery. Secondary end points included disease-free and overall survival. A total of 1044 patients were included (699 in the laparoscopic-surgery group and 345 in the open-surgery group). At 3 years, the locoregional recurrence rate was 5.0% in the two ...
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.
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.