Laparoscopic low vs. high anterior resection for rectal cancer

Abstract

In the October issue of Surgical Endoscopy, Kuroyanagi and colleagues evaluated laparoscopic low anterior resection for lower rectal cancer by double-stapling technique (DST). Current and emerging rapid technological advances allow biomedical research and applied sciences important progress in the development of new drugs and medical devices for improving outcomes of patients with solid cancer. In the field of translational research, modern molecular technology-based advances in genetics, genomics, and systems biology allow optimism for developing new markers and novel targeted drugs. This high-throughput technology has already resulted in excellent research findings, which are now incorporated in a large number of targeted agents, which are tested in preclinical and clinical trials [2–8]. In contrast to these future expectations, laparoscopic or robotic surgery can immediately improve short-term and long-term quality of life of patients with colorectal, gastric, and other solid tumors [9–13]. To test the safety efficacy of new drugs and medical devices, as minimally invasive techniques, the U.S. Food and Drug Administration (FDA) has established strict criteria for approval, ensuring a highquality public health. Comparative-effectiveness research (CER) is currently required for approval of new therapies in medical practice. However, whereas phase III, randomized, controlled trials are required for new drugs before these can become widely used, no CER data are required by the FDA for medical devices approval [14]. Therefore, careful evaluation of current data is required to assess the safety and efficacy of laparoscopic surgery in solid cancers. The best tool of CER—phase III trials and meta-analyses—has provided good-quality evidence for the safety and superiority of laparoscopic surgery over open resection, regarding short-term outcomes for colon cancer [15]. But particularly for low rectal cancer, evidence for the superiority of laparoscopic versus open surgery is still scarce. Kuroyanagi et al. provide useful information for this location of cancer in the lower rectum. The authors compared clinicopathological features and short-term results between two groups: 98 patients with upper rectal cancer located between 75 and 150 mm from the anal verge (group A), and 61 with lower rectal cancer located within 75 mm from the anal verge (group B). There was no difference in operating time, and intraoperative blood loss was similar in the two groups. No conversion in both groups was required. There was no perioperative death in either group. Anastomotic leak rate was similar in the two groups (2% in group A vs. 3.3% in group B; p = 0.638). The authors concluded that laparoscopic surgery is safe and feasible for lower rectal cancer in a very select group of patients. The study is limited by the small number of patients with lower rectal cancer, their selection, the absence of randomization, and the lack of follow-up data to assess its efficacy regarding locoregional recurrence and survival. All these limit its power. But the participation of very experienced surgeons with laparoscopic low anterior resection has resulted in the safety of the procedure with E. Hanisch (&) Department of Surgery, Asklepios Klinik Langen, Academic Teaching Hospital JWG University Frankfurt, 63225 Langen, Germany e-mail: E.Hanisch@Asklepios.com