Assessment of the short -term res ults of laparoscopic vers us open surgery for distal rectal cancer after neoadj uvant therapy

Abstract

Rectal cancer (RC) rate increases. According to the Bulgarian National Cancer Registry, in 2010 1893 new patients are registered. RR is characterized with specific diagnostic and treatment. Neoadjuvant radiotherapy is a standard in the complex treatment of the T3 tumours leading to reduction of the local recurrence rate. Laparoscopic anterior resection is accepted as a standard in some European and Asian countries, despite some controversial data. There is no significant difference in the 5-year overall survival rate between laparoscopic and open group. Laparoscopic surgery for RR is characterized with more frequent infiltration of the circumferential margin compared to the open surgery. There is no difference in survival between these two groups. Increased perioperative mortality and worse 5-year survival is found in patients with conversion from laparoscopic to open operation. For the period 2008-2012, in thje Clinic of Surgery of MMA and Eurohospital Plovdiv, 120 patients with RC undergo surgery - 68 (56%) for distal cancer and 52 (44%) for cancer in the upper third of the rectum. Some 78 open and 42 (35%) laparoscopic resections are performed. Patients with distal rectal cancer undergo 28 (41%) mini-invasive procedures and 40 open resections. Laparoscopic resections are divided in three groups (low anterior resections - 12, ultralow anterior resections with coloanal anastomosis - 8, video-assissted rectal amputations - 8). All patients undergo neoadjuvant therapy. We have 5 patients with complete pathoanatomical response after neoadjuvant chemoradiotherapy. We don`t find infiltration of the circumferential margin after laparoscopic or open resection. There is R1 involvement in 2 patients after open and in one after laparoscopic resection. The laparoscopic anterior resection is characterized with lower blood loss (160 vs. 250 mL), longer operation time (190 vs. 130 min), faster recovery of the bowel function and shorter hospital stay (6 vs. 9 days). Laparoscopic rectal surgery is successful alternative of the open procedure leading to similar long-term results. When performed after neoadjuvant therapy by trained laparoscopic team it leads to low rates of conversion and circumferential margin infiltration, less pain and faster bowel function recovery.