LAPAROSCOPIC VERSUS OPEN SURGERY FOR NODE POSITIVE RECTAL CANCER: A RETROSPECTIVE ANALYSIS OF RECTAL CANCER PATIENTS IN A SINGLE INSTITUTION

Dr. Srinivas C, Dr. Pavan kumar J, Dr. C Ramachandra

Abstract


INTRODUCTION: Colorectal cancer is the third most common cancer and ranks second in terms of mortality. Rectal cancers are biologically
aggressive. Implementation of laparoscopy in the management of rectal cancers is challenging and oncological outcomes should be comparable
with open surgery before widespread application of laparoscopy. This study is performed to assess laparoscopic versus open surgery in the
management of rectal cancer.
MATERIALS AND METHODS: This is a retrospective analysis of 112 patients who under went open or laparoscopic surgery for rectal cancer.
Both the groups were analysed in terms of operative time and post-operative complications and oncological outcomes.
RESULTS: Of 112 patients with rectal cancer surgery, 53.6% (n=60) underwent open surgery and 46.4% (n=52) underwent laparoscopic surgery.
The median age of patients in our study is 52 years with range 21-80 years. 60.7% were males. Conversion rate in our study is 3.6%. The major
reason for conversion is bleeding. Majority belong T3, N1b, and stage IIIB. No statistically significant differences were observed between the two
groups in terms of blood loss, complications, recurrence, 5-year Disease free survival (DFS) and overall survival (OS). There was a significant
difference observed between the two groups in regard to operative time. Laparoscopic surgery is 40 min longer than open surgery for rectal cancer.
CONCULSION: Laparoscopic surgery has longer operative times than open surgery. However, laparoscopic and open have comparable equal
efficacy in relation to post-operative complications, oncological outcomes.


Full Text:

PDF

References


Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R. L., Torre, L. A., & Jemal, A. (2018). Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians.

Brenner H, Bouvier AM, Foschi R, Hackl M, Larsen IK, Lemmens V, Mangone L, Francisci S, EUROCARE Working Group. Int J Cancer. 2012 Oct 1; 131(7):1649-58.

van de Velde CJ, Boelens PG, Borras JM, et al. EURECCA colorectal: multidisciplinary management: European consensus conference colon & rectum. Eur J Cancer. 2014;50:1.e1–34.

Lacy AM, Garcia-Valdecasas JC, Delgado S, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 2002; 359:2224–2229.

COST group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004; 350:2050–2059.

Bonjer HJ, Haglind E, Jeekel I, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 2005; 6:477–484.

Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 2005; 365:1718–1726.

Kang SB, Park JW, Jeong SY, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 2010; 11:637–645.

van der Pas MH, Haglind E, Cuesta MA, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 2013; 14:210–218.

Stevenson AR, Solomon MJ, Lumley JW, et al. Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA 2015; 314:1356–1363.

Fleshman J, Branda M, Sargent DJ, et al. Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA 2015; 314:1346–1355.

Toda S, Kuroyanagi H. Laparoscopic surgery for rectal cancer: current status and future perspective. Asian J Endosc Surg2014; 7:2–10.

M. Buunen, R. Veldkamp, W. C. Hop et al., “Survival after laparo-scopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial,” The Lancet Oncology, vol. 10, no. 1, pp. 44–52, 2009.

T. Lourenco, A. Murray, A. Grant, A. McKinley, Z. Krukowski, and L. Vale, “Laparoscopic surgery for colorectal cancer: safe and effective?—A systematic review,” Surgical Endoscopy and other Interventional Techniques, vol. 22, no. 5, pp. 1146–1160, 2008.

L. L. Swanström and N. J. Soper, Eds., Mastery of Endoscopic and Laparoscopic Surgery, Lippincott Williams & Wilkins, Philadelphia, Pa, USA, 4th edition, 2014.

Araujo SE, da Silva eSousa AH, de Campos FG, et al. Conventional approach x laparoscopic abdominoperineal resection for rectal cancer treatment after neoadjuvant chemoradiation: results of a prospective randomized trial. Rev Hosp Clin Fac Med Sao Paulo. 2003;58:133–40.

J. D. Rea, M. M. Cone, B. S. Diggs, K. E. Deveney, K. C. Lu, and D. O. Herzig, “Utilization of laparoscopic colectomy in the United States before and after the clinical outcomes of surgical therapy study group trial,” Annals of Surgery, vol. 254, no. 2, pp. 281–288, 2011.

Małczak, P., Mizera, M., Torbicz, G., Witowski, J., Major, P., Pisarska, M., … Pędziwiatr, M. (2018). Is the laparoscopic approach for rectal cancer superior to open surgery? A systematic review and meta-analysis on short-term surgical outcomes. Videosurgery and other miniinvasive techniques, 13(2), 129–140.

Zhang F, Zhou Z, Wang H, Zhang J, Di B, Huang W et al. Laparoscopic Versus Open Surgery for Rectal Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Asian Pacific Journal of Cancer Prevention. 2014;15(22):9985-9996.


Refbacks

  • There are currently no refbacks.