Open Rectal Cancer Resection Research Articles

PWE-371 Clinical outcomes of patients undergoing laparoscopic vs open surgery for rectal cancers

Introduction Laparoscopic resection of rectal cancer has been approached with caution, especially after chemoradiation, in view of the results of the MRC CLASICC trial. Two more recent trials, the COREAN trial and the COLOUR II trial, show equivalent results with laparoscopic and open resection of the rectum. We evaluated the perioperative and short term oncological results of a consecutive series of unselected patients with operable rectal cancer treated open or laparoscopic proctectomy in a one-year period. Method All patients with rectal cancer operated at the specialist colorectal unit in the one-year period from July 2013 to June 2014 were evaluated. Patients with inoperable disease at laparoscopy/ laparotomy or those who underwent pelvic exenteration were excluded from the study. 258 consecutive unselected patients of operable rectal cancer, who underwent potentially curative resection of the rectum (laparoscopic or open) during the study period were included in the study. Data was obtained from a prospectively maintained database and analysed. Results Eight three patients underwent laparoscopic and 175 patients underwent open resection of the tumours, depending on availability of laparosopic instruments in the operation theatre. Adenocarcinoma was the most common histology (92%). Median distance of the lower edge of the tumour from the anal verge was 5cm in both groups. The majority (87.5%) of the tumours were staged either cT3+ (74%) or cN+ (72%) or both at initial staging. Overall, 64% of patients received pre-operative radiotherapy. Mean BMI of patients was 23. The overall sphincter preservation rate was 70% (73% in open group and 64% in laparoscopic group which may be the result of a larger fraction of tumours within 5cm of the anal verge in the laparoscopic group). The overall blood loss was lower in laparoscopic group (median 200mL) than open group (median 500mL). The postoperative stay was only slightly lower in the laparoscopic group (mean 7.3 days) than open group (mean 8.4 days). CRM positivity was similar in both groups (3.6% laparoscopic versus 4% open group). Median nodal harvest was similar in both groups (12 nodes). Conclusion Laparoscopic resection of the rectum is at least as good as open resection for rectal cancer with similar short-term oncological outcomes and improved perioperative outcomes. Disclosure of interest None Declared.

The role of the laparoscopy on circumferential resection margin positivity in patients with rectal cancer: long-term outcomes at a single high-volume institution.

The aim of this study was to evaluate the influence of laparoscopic rectal cancer surgery on circumferential resection margin (CRM) involvement. The data from 579 consecutive patients who underwent laparoscopic or open resection of rectal cancer from October 2002 to August 2008 were analyzed retrospectively. The primary endpoint was CRM status. The secondary endpoints were morbidity, local recurrence rate, overall survival, and disease-free survival. Laparoscopic resections were performed in 266 patients (46%), and the remainder of the patients underwent open resection. The rates of CRM involvement were similar between the laparoscopic and open groups (5.6% vs. 5.4%). The perioperative morbidity rates between the 2 groups were not significantly different (P=0.2). The incidence of local recurrence for the CRM-negative group was 8.4% (8.3% laparoscopic vs. 8.45% open; P=0.99), whereas the local recurrence rate was 34.3% for the CRM-positive group. The local recurrence rate was 20% for the CRM-positive patients in the laparoscopic group and 47% for the CRM-positive patients in the open group (P<0.001). We did not observe any significant differences in local recurrence rates between the Lap R and Open R groups after omitting CRM status. CRM positivity was correlated with both 5-year survival and the 5-year disease-free survival rate (P=0.009 and P=0.001, respectively). We did not observe any significant differences in morbidity, local recurrence, or overall or disease-free survival rates between the overall laparoscopic and open resection groups. Laparoscopic surgery for rectal cancer is associated with similar complication rates, CRM involvement status, and long-term outcomes as those associated with open surgery but with the advantages of minimally invasive surgery. Although laparoscopic surgery might necessitate more advanced technical skills, similar long-term oncological results can be obtained with this technique.

Long-term Outcomes of Laparoscopic versus Open Surgery for Rectal Cancer: A Single-center Retrospective Analysis.

Laparoscopic surgery has been proven to be an effective alternative to open surgery in patients with colon cancer. However, data on laparoscopic surgery in patients with rectal cancer are insufficient. The aim of this study was to compare the long-term outcomes of laparoscopic and open surgery in patients with rectal cancer. A total of 307 patients with rectal cancer who were treated by open and laparoscopic curative resection at Kosin University Gospel Hospital (Busan, Korea) between January 2002 and December 2011 were reviewed retrospectively. Regarding treatment, 176 patients underwent an open procedure and 131 patients underwent a laparoscopic procedure. The local recurrence rate after laparoscopic resection was 2.3%, compared with 5.7% after open resection (p = 0.088). Distant metastases occurred in 6.9% of the laparoscopic surgery group, compared with 24.4% in the open surgery group (p < 0.001). In univariate analysis, age (≥ 75 years vs. ≤ 60 years), preoperative staging, surgical approach (open vs. laparoscopic), elevated initial CEA level, elevated follow-up CEA level, number of positive lymph nodes, and postoperative chemotherapy affected overall survival and disease free survival. However, in multivariate analysis, the surgical approach apparently did not affect long-term oncologic outcome. In this study, long-term outcomes after laparoscopic surgery for rectal cancer were not inferior to those after open surgery. Therefore, laparoscopic surgery would be an alternative operative tool to open resection for rectal cancer, although further investigation is needed.

Outcome of laparoscopic versus open resection for rectal cancer in elderly patients

BackgroundLaparoscopic colorectal resection has been gaining popularity over the past two decades. However, studies about laparoscopic rectal surgery in elderly patients with long-term oncologic outcomes are limited. In this study, we evaluated the short-term and long-term outcomes of laparoscopic and open resection in patients with rectal cancer aged ≥70 y. MethodsFrom 2007–2012, a total of 294 consecutive patients with rectal cancer from a single institution were included, 112 patients undergoing laparoscopic rectal resection were compared with 182 patients undergoing open rectal resection. ResultsSeven (6.3%) patients in the laparoscopic group required conversion to open surgery. The two groups were well balanced in terms of age, gender, body mass index, American society of anesthesiologists scores, site, and stage of the tumors. Laparoscopic surgery was associated with significantly longer median operating time (220 versus 200 min; P = 0.005), less estimated blood loss (100 versus 150 mL; P < 0.001), a shorter postoperative hospital stay (8 versus 11 d), lower overall postoperative complication rate (15.2% versus 26.4%; P = 0.025), wound-related complication rate (7.14% versus 17.03%; P = 0.015), less need of blood transfusion (8.04% versus 16.5%; P = 0.038), and surgical intensive care unit after surgery (12.5% versus 22.0%; P = 0.042) when compared with open surgery. Mortality, quality of surgical specimen, lymph nodes harvested, positive distal, and circumferential margin rate were not significantly different between two groups. The estimated 3-y survival rates were similar between two groups. ConclusionsLaparoscopic rectal surgery is safe and feasible in patients >70 y and is associated with better short-term outcomes when compared with open surgery.

Baseline Mortality-Adjusted Survival in Resected Rectal Cancer Patients

BackgroundThis investigation assessed the baseline mortality-adjusted 5-year survival after open rectal cancer resection. MethodsThe 5-year survival rate was analyzed in 885 consecutive American Joint Committee on Cancer (AJCC) stage I–IV rectal cancer patients undergoing open resection between 2002 and 2011 using risk-adjusted Cox proportional hazards regression models adjusted for population-based baseline mortality. ResultsThe 5-year relative and overall survival rates were 80.9 %(95 % confidence interval (CI): 77.0–85.0 %) and 71.9 %(95 % CI, 68.4–75.5 %), respectively. The 5-year relative survival rates for stage I, II, III, and IV cancer were 97.8 % (95 % CI, 93.1–102.8 %), 90.9 %(95 % CI, 84.3–98.1 %), 72.0 % (95 % CI, 64.7–80.1 %), and 24.4 % (95 % CI: 16.0–37.0 %), respectively. After the curative resection of stage I–III rectal cancer, fewer than every other observed death was cancer-related. The 5-year relative survival rate for stage I cancer did not differ from the matched average national baseline mortality rate (P = 0.419). Higher age (hazard ratio (HR) 0.94, 95 % CI: 0.92–0.95, P < 0.001) was protective for relative survival but unfavorable for overall survival (HR 1.04, 95 % CI: 1.02–1.05, P < 0.001). Female gender was only unfavorable for relative survival (HR 1.59, 95 % CI: 1.11–2.29, P = 0.014). ConclusionThe analysis of relative survival in a large cohort of rectal cancer patients revealed that stage I rectal cancer is fully curable. The findings regarding age and gender may explain the conflicting results obtained to date from studies based on overall survival.

Postoperative bladder and sexual function in patients undergoing surgery for rectal cancer: a systematic review and meta-analysis of laparoscopic versus open resection of rectal cancer.

There have been conflicting opinions regarding the superiority of open and laparoscopic surgery in preserving bladder and sexual function after rectal cancer surgery. This systematic review and meta-analysis aims to pool the available data comparing the impact of surgical approaches on postoperative sexual and urinary function. A search of Pubmed, Medline, Cochrane and Embase was undertaken and studies from January 2000 to February 2013 were identified. We included, in our meta-analysis, both prospective and retrospective studies that compared laparoscopic surgery and open surgery for rectal cancer. A total of 876 patients undergoing rectal cancer surgery (lap n = 468, open n = 408) were examined. In men, postoperative ejaculatory function and erectile dysfunction evaluated from two studies comprising of 74 patients showed no difference between groups. The rate of overall sexual dysfunction evaluated from five studies comprising of 289 patients revealed a rate of 34 % in both the open and lap groups. Postoperative urinary function evaluated from five studies comprising of 312 patients showed no difference between groups. In women, postoperative sexual and urinary function were evaluated from five studies comprising of 321 patients. Three studies (n = 219) reported no difference in sexual function between groups. Postoperative urinary function evaluated from four studies comprising of 212 patients was found to be comparable. The available data are limited, but suggest that neither form of surgical approach be it laparoscopy or open surgery demonstrate superiority in preservation of sexual and bladder function. Further research into the technical aspects of surgery and evaluating newer minimally invasive technologies such as the robot may prove to be useful in improving functional outcomes of rectal cancer patients.

Outcome of Tumor‐Specific Mesorectal Excision for Rectal Cancer: The Impact of Laparoscopic Resection

The study aimed to compare the outcomes of laparoscopic and open resection for rectal cancer in 1,063 consecutive cases in a single center. We performed an analysis of 11 years of experience in rectal cancer surgery and compared the outcome of laparoscopic and open surgery. Multivariate and subgroup analysis was performed to look at the effect of the level of tumor and stage of disease on short-term outcomes like conversion rate, anastomotic leak rate, length of stay, complication rate, 30-day mortality, and long-term outcomes like local recurrence and survival. A total of 1,063 patients underwent rectal resection with 470 (44.2%) patients undergoing the laparoscopic approach. Groups were comparable in terms of age, sex, or co-morbidities, and the operating time was longer in the laparoscopic group (210 vs. 150 min; p value < 0.001). A conversion rate of 6.8% was noted, with an anastomotic leak rate of 3.87% in the open group and 2.97% in the laparoscopic group. The laparoscopic group had a lower blood loss (100 vs. 350 ml; p < 0.001), lower complication rates, and shorter length of stay (6 vs. 9 days). The local recurrence rate was comparable, and the laparoscopic approach had better overall and cancer-specific survival, even after adjusting for stages. The laparoscopic approach was an independent factor associated with better overall and cancer-specific survival on multivariate analysis. We confirmed the oncological safety of laparoscopic rectal cancer surgery. Laparoscopic surgery also showed superiority in the short-term and long-term outcomes of rectal cancer.

Intraoperative rectal washout in rectal cancer surgery: A survey of current practice in the UK

ObjectivesDue to concerns about implantation of malignant cells during surgery for rectal cancer, traditionally, intraoperative rectal washout (IORW) has been performed to prevent local recurrence. But with the advent of laparoscopic surgery, many surgeons have abandoned this practice. The aim of this study was to assess current practice among colorectal surgeons in the UK. MethodsA 10-item questionnaire was sent by email to 452 consultant surgeons, who were members of the Association of Coloproctology of Great Britain & Ireland, and had previously agreed to participate in research projects. ResultsThe mean age of the 149 responders (n = 149, 33.0%) was 49.2 years. The mean number of years in independent practice was 12.1, and the mean number of rectal cancer cases performed per year was 20.3 and 20.6, in the years 2010 and 2011 respectively. 74.3% of the responders believed that there is an advantage in performing IORWs in rectal cancer resections. Of the 71.8% of all responders who performed laparoscopic rectal cancer resections, 54.8% routinely performed IORWs during laparoscopic resections. However, 87.2% of all responders performed IORWs in open resections for rectal cancer, and 79.2% had routinely performed IORWs before the advent of laparoscopic rectal cancer surgery. ConclusionsMost colorectal surgeons believe that there is an advantage in performing IORWs. Although, most surgeons would routinely perform IORWs in open resections, they do not routinely perform these in laparoscopic resections.

Laparoscopy for extraperitoneal rectal cancer reduces short-term morbidity: Results of a systematic review and meta-analysis.

The role of laparoscopy in the treatment of extraperitoneal rectal cancer is still controversial. The aim of the study was to evaluate differences in safety of laparoscopic rectal resection for extraperitoneal cancer, compared with open surgery. A systematic review from 2000 to July 2012 was performed searching the MEDLINE and EMBASE databases (PROSPERO registration number CRD42012002406). We included randomized and prospective controlled clinical studies comparing laparoscopic and open resection for rectal cancer. Primary endpoints were 30-day mortality and morbidity. Then a meta-analysis was conducted by a fixed-effect model, performing a sensitivity analysis by a random-effect model. Relative risk (RR) was used as an indicator of treatment effect. Eleven studies, representing 1684 patients, met the inclusion criteria: four were randomized for a total of 814 patients. Mortality was observed in 1.2% of patients in the laparoscopic group and in 2.3% of patients in the open group, with an RR of 0.56 (95% CI 0.19-1.64, p = 0.287). The overall incidence of short-term complications was lower in the laparoscopic group (31.5%) compared to the open group (38.2%), with an RR of 0.83 (95% CI 0.73-0.94, p = 0.004). Surgical complications, wound complications, blood loss and the need for blood transfusion, time for bowel movement recovery, food intake recovery, and hospital stay were significantly lower or less frequent in the laparoscopic group. The incidence of intra-operative injuries, anastomotic leakages, and surgical re-interventions was similar in the two groups. Only operative time was in favour of the open group. Based on the evidence of both randomized and prospective controlled series, mortality was lower after laparoscopy although not significantly so, while the short-term morbidity RR, including subgroup analysis, was significantly lower after laparoscopy for extraperitoneal rectal cancer compared to open surgery.

Laparoscopy for rectal cancer reduces short-term mortality and morbidity: results of a systematic review and meta-analysis

Although definitive long-term results are not yet available, the global safety of laparoscopic surgery for rectal cancer treatment remains controversial. We evaluated differences in the safety of laparoscopic rectal resection versus open surgery for cancer. A systematic review from 2000 to 2011 was performed searching the Medline and Embase databases (prospero registration CRD42012002406). We included randomized and prospective controlled clinical studies comparing laparoscopic and open resection for rectal cancer. Primary end points were 30-day mortality and overall morbidity. Then a meta-analysis was conducted by a fixed-effect model, performing a sensitivity analysis by a random-effect model. Relative risk (RR) was used as an indicator of treatment effect; a RR of less than 1.0 was in favor of laparoscopy. Publication bias was assessed by funnel plot and heterogeneity by the I (2) test and subgroup analysis on surgical and medical complications. Twenty-three studies, representing 4,539 patients, met the inclusion criteria; eight were randomized for a total of 1,746 patients. Mortality was observed in 1.0 % of patients in the laparoscopic group and in 2.4 % of patients in the open group. The overall RR was 0.46 (95 % confidence interval 0.21-0.99, p = 0.048). The raw incidence of overall complications was lower in the laparoscopic group (31.8 %) compared to the open group (35.4 %). The overall RR was 0.83 (95 % confidence interval 0.76-0.91, p < 0.001). On the basis of evidence of both randomized and prospective controlled series, mortality and morbidity RR, including subgroup analysis, were significantly lower after laparoscopic compared to open surgery.

Robotic versus open rectal resection for cancer: Comparison of clinical and oncological results

Robotic versus open rectal resection for cancer: Comparison of clinical and oncological results

Comunicazione orale: Robot-assisted rectal resection with total mesorectal excision

Comunicazione orale: Robot-assisted rectal resection with total mesorectal excision

Laparoscopic versus Open Surgery for Rectal Cancer: A Clinical Comparative Study

To compare short-term surgical outcomes and long-term survival following laparoscopic or open resection for rectal cancer. A total of 381 patients undergoing laparoscopic surgery and 276 undergoing open surgery for curative resection of rectal cancer were included. Long-term survival and peri- and postoperative data were retrospectively reviewed from a prospectively-collected database. Surgical groups were comparable regarding age, gender, tumour stage and preoperative comorbidities. Laparascopic surgery was associated with significantly longer duration of surgery, less intraoperative blood loss and fewer postoperative infections than open surgery. Patients who underwent laparoscopic resection had significantly earlier recovery of gastrointestinal function than those who underwent open surgery. There were no significant between-group differences in number of lymph nodes excised, specimen length or distal margin. The 3- and 5-year survival rates and overall survival were similar in the two groups, and survival was not influenced by tumour location. Laparoscopic surgery can achieve the same oncological results as open resection in patients with rectal cancer, supporting its continued use in the management of this disease.

Laparoscopic vs open resection for rectal cancer: a meta‐analysis of randomized clinical trials

Laparoscopic and open rectal resection for cancer were compared by analysing a total of 26 end points which included intraoperative and postoperative recovery, short-term morbidity and mortality, late morbidity and long-term oncological outcomes. We searched for published randomized clinical trials, presenting a comparison between laparoscopic and open rectal resection for cancer using the following electronic databases: PubMed, OVID, Medline, Cochrane Database of Systematic Reviews, EBM Reviews, CINAHL and EMBASE. Nine randomized clinical trials (RCTs) were included in the meta-analysis incorporating a total of 1544 patients, having laparoscopic (N = 841) and open rectal resection (N = 703) for cancer. Laparoscopic surgery for rectal cancer was associated with a statistically significant reduction in intraoperative blood loss and in the number of blood transfusions, earlier resuming solid diet, return of bowel function and a shorter duration of hospital stay. We also found a significant advantage for laparoscopy in the reduction of post-operative abdominal bleeding, late intestinal adhesion obstruction and late morbidity. No differences were found in terms of intra-operative and late oncological outcomes. The meta-analysis indicates that laparoscopy benefits patients with shorter hospital stay, earlier return of bowel function, reduced blood loss and number of blood transfusions and lower rates of abdominal postoperative bleeding, late intestinal adhesion obstruction and other late morbidities.

Urogenital function following laparoscopic and open rectal cancer resection: a comparative study

Sexual and urinary dysfunction is an established risk after pelvic surgery. Studies examining sexual and urinary function following laparoscopic and open rectal surgery give conflicting evidence for outcomes. The purpose of this study was to analyse the impact of the surgical technique on functional outcomes following laparoscopic or open resection for rectal cancer patients in a high-volume laparoscopic unit. All patients who underwent elective laparoscopic or open surgery for rectal cancer between September 2006 and September 2009 were identified from a prospectively collated database. Validated standardized postal questionnaires were sent to surviving patients to assess their postoperative sexual and urinary function. The functional data were then quantified using previously validated indices of function. A total of 173 patients were identified from the database, of whom 144 (83 %) responded to the questionnaire-based study. Seventy-eight respondents had undergone laparoscopic rectal resection (49 men and 29 women), and 65 had an open procedure (41 men and 24 women). Both open surgery and laparoscopic surgery were associated with deterioration in urinary and sexual function. With regard to urinary function, there was no difference in the deterioration in open and laparoscopic groups in either gender. With regard to sexual function, in males one component of sexual function, namely, the incidence of successful penetration, showed less deterioration in the laparoscopic group (p = 0.04). However, in females, laparoscopic surgery was associated with significantly better outcomes in all aspects of sexual activity, specifically sexual arousal (p = 0.005), lubrication (p = 0.001), orgasm (p = 0.04), and the incidence of dyspareunia (p = 0.02). Laparoscopic total mesorectal excision for rectal cancer is associated with significantly less deterioration in sexual function compared with open surgery. This effect is particularly pronounced in women.

Sexual and urinary dysfunctions following laparoscopic resection for rectal cancer

Laparoscopic resection for rectal cancer has increasingly gained support over the last years. Sexual and urinary functions are two elements pertaining to the Quality Of Life (QOL) that may be significantly altered. Postoperative urinary and sexual dysfunctions resulting from damage to the autonomic nervous system are recognized complications following rectal surgery. Laparoscopic surgery can potentially facilitate preservation of these nerves. However, there are insufficient data in the literature addressing this issue. A systematic review of the literature was carried out using PUBMED/MEDLINE data-bases to identify all studies that compare laparoscopic vs. open resection of rectal cancer using Total Mesorectal Excision (TME) that include results on QOL for the patients. The purpose of this article is to systematically review the current literature reporting sexual and urinary functions following laparoscopic rectal surgery to determine possible risk factors and identify questions that should be addressed in the future.

Laparoscopic rectal cancer surgery

Barely a century after his publication on surgical technique for rectal cancer, Ernest Miles would have found it surprising that the most vociferous debate is not the pursuit of oncological perfection, but the size of incision. Miles was able to reduce his almost 100 per cent local recurrence rate to less than 50 per cent during his own lifetime through technical refinement1. More recently, and despite the increasing popularity of adjuvant therapies, it is the acceptance of a standardized surgical technique, total mesorectal excision (TME)2, that has been the single most important factor in improving survival and lowering recurrence rates further after rectal cancer surgery. Whether we have reached a plateau in terms of oncological success is contentious. If this is not the case, then a debate on laparoscopic versus open resection of rectal cancer is hardly appropriate but, for the sake of argument, let us suppose that we have achieved excellence in open surgery and turn our attention to laparoscopy. Laparoscopic resection seems a safe and feasible alternative to open surgery in colonic cancer3. The subtleties of pelvic surgery, however, may not make rectal cancer entirely ideal for laparoscopy or indeed immediately comparable. Anatomical, oncological and functional factors become even more important when planning surgery. The rectum is related to both neural and visceral structures in the pelvis far more intimately than the colon within the abdominal cavity. Minimal disturbance to these structures can have profound functional effects for the patient. The main opposition to laparoscopic rectal resection is fear of oncological inadequacy. Careful scrutiny of pathological specimens allows resections to be assessed qualitatively4. Current evidence suggests that local recurrence, lymph node harvest and oncological clearance are not compromised and may be equivalent to those of open surgery5. These ‘primary markers’ of outcome have, however, generally not been emphasized as much as lesser benefits such as shorter length of stay (LOS) and earlier return of bowel function. Sexual and urological dysfunction have been even less well documented. It seems that LOS has become a symbol of bravado for some surgeons – discharging patients before they have had a chance to settle into their hospital beds is now heralded as a sign of success. Day-case colectomies and anterior resections appear to be on the horizon. It is important that surgeons should not become overly obsessed with surrogate markers and short-term objectives. LOS, for example, may be an issue in socialized healthcare systems or in private hospitals, but this may not be a problem in many countries where cultural factors influence bed occupancy. Essentially, LOS has minimal effect on patient care and, ultimately, long-term outcome. Furthermore, it is debatable whether a reduction inLOSmay be attributed to technical aspects of the actual surgery, the motivations of the surgeon or more general approaches. For example, enhanced recovery programmes are frequently associated with laparoscopic surgery but many of their components would be equally suitable in open surgery, and may flatter LOS outcomes attributed directly to laparoscopy. Most reports, however, do show a decreased LOS for patients undergoing laparoscopic rectal cancer surgery compared with its open counterpart. Laparoscopy involves less handling, manipulation and forcible retraction of the bowel, with less likelihood of ileus. It seems reasonable to conclude that laparoscopic surgery does lead to a faster recovery and return to normal life. Early criticisms of laparoscopy largely ignored the effect of the steep learning curve on results. During the early trials, most surgeons had far greater experience in open surgery than laparoscopy. The principles of good open surgery are relevant to laparoscopy. Traction and countertraction allow precise dissection, but translating these elements along with other techniques to laparoscopy takes time. Learning curves affect not only technique but also the outcome of the operation, such as lymph node harvest, intraoperative complications and conversion rates6. One of the difficulties in laparoscopy that leads to conversion is indecision due to anatomical uncertainty. Laparoscopy provides an initially unfamiliar anatomical perspective requiring new pattern recognition that is eliminated only through experience. Appreciating when to convert to laparotomy seems important and there is evidence that late conversion leads to worse outcomes,

Impact of laparoscopic surgery on bladder and sexual function after total mesorectal excision for rectal cancer

Bladder and sexual dysfunction are well-documented complications of rectal cancer surgery. This study aimed to determine whether laparoscopy can improve the outcome of these dysfunctions or not. The study included 63 of the 116 patients who underwent surgery for rectal cancer between 2002 and 2006. Bladder and male sexual function were studied by means of a questionnaire on the basis of the International Prostatic Symptom Score (IPSS) and International Index of Erectile Function (IIEF). In addition, bladder function was determined by means of postvoid residual urine measurement and uroflowmetry. Postoperative functions were compared with the preoperative data to detect subjective functional deterioration. Outcomes were compared between patients who underwent open (group 1, n = 29) and laparoscopic (group 2, n = 34) total mesorectal excision. Only minor disturbances of bladder function were reported for one patient (3%) in group 1 and three patients (9%) in group 2 (p > 0.05). Impotency after surgery was experienced by 6 of 17 preoperatively sexually active males (29%) in group 1 and 1 of 18 males (5%) in group 2 (p = 0.04). Similarly, 5 of 10 women (50 %) in group 1 and 1 of 14 women (7%) in group 2 felt that their overall level of sexual function had decreased as a result of surgery (p = 0.03). Open rectal cancer resection is associated with a higher rate of sexual dysfunction, but not bladder dysfunction, compared with laparoscopic surgery. Laparoscopic rectal cancer surgery offers a significant advantage with regard to preservation of postoperative sexual function and constitutes a true advance in rectal cancer surgery compared with the open technique. The proposed advantages can be attributed to improvement in visibility by the magnification feature of laparoscopic surgery.

Anastomotic Leakage after Laparoscopic versus Open Resection for Rectal Cancer: - A Retrospective Study -

Purpose: This study is to compare the rate and pattern of anastomotic leakage (AL) for rectal cancer after laparoscopic vs. conventional open surgery at high and low rectal anastomosis and to evaluate whether the number of linear staples used for distal rectal resection is related to AL in laparoscopic group. Methods: One hundred ninety-seven patients who underwent a curative resection for rectal cancer between March 2002 and February 2006 were studied retrospectively (107 laparoscopic, 90 open). The proportions of patients with anastomosis above vs. below 5 cm from AV were not different between the laparoscopic and the open groups; (above/below: 54/53 and 41/49, respectively, P=0.57). The protective stoma rate, the overall rate of AL, the rate of AL according to the height of the anastomosis, and the number of distal linear staples were evaluated for both groups. Results: Clinical AL occurred in 11 of 107 patients (10.3%) for the laparoscopic group and in 5 of 90 patients (5.6%) for the open group. The rates of AL in patients without protective stoma were not significantly different for high rectal anastomosis (6.0% for laparoscopic vs. 2.6% for open, P= 0.63) and for low rectal anastomosis (25.8% for laparoscopic vs. 12.1% for open, P=0.21). The risk of AL was 4.9 times higher when 3 linear staples were used than when 2 linear staples were used in the laparoscopic group. Conclusions: There was no statistical difference in AL between the laparoscopic group and the open group. The rate of AL could be reduced by using fewer linear staples for distal rectal resection in the laparoscopic group.

Long-term results of laparoscopic vs open resections for rectal cancer in 124 unselected patients

Background: Controversy continues to surround laparoscopic rectal resection for malignancy. A longer follow-up period is required to evaluate the long-term efficacy of the procedure and its impact on survival. Furthermore, no data from ongoing randomized controlled trials are yet available. The aims of this study were to compare long-term outcomes for unselected patients undergoing either laparoscopic or open rectal resection for cancer. Methods: A series of 124 unselected consecutive patients with rectal cancer, who underwent surgery by the same surgical team, have been included in this study. Patients with T1N0 tumors underwent local excision, and emergency cases were excluded from the study. Written consent was submitted by each patient, and inclusion in either group (laparoscopic or open) was left to the patient’s choice. The laparoscopic approach was chosen by 81 patients, and 43 patients chose open surgery. All the patients underwent preoperative radiotherapy (5,040 cGy), performed in selected cases with chemotherapy (for patients younger than 70 years). The following parameters were compared between the two groups: length of the surgical specimen, clearance of the margins of the specimen, number of lymph nodes identified, local recurrence rate, incidence of distant metastases, and survival probability analysis. The mean follow-up period for both groups was 43.8 months (range, l–9 years). Results: We performed 60 laparoscopic and 27 open anterior resections, as well as 21 laparoscopic and 16 open abdomino perineal resections, respectively. No mortality occurred in either group. The mean length of the resected specimens was 24.3 cm in the laparoscopic group and 23.8 cm in the open group (p = 0.47). The mean tumor-free margin was 3.0 cm in the laparoscopic group and 2.8 cm in the open group (p = 0.57), and the mean number of lymph nodes identified was 10.3 in the laparoscopic group and 9.8 in the open group (p = 0.63). Of the 124 patients, 86 (52 laparoscopic and 34 open) were included in out study. We excluded patients who underwent a palliative resection (6 laparoscopic and 6 open patients) or conversion to open surgery (n = 10) and patients who had undergone surgery in the past year (n = 16). One laparoscopic patient was lost to follow-up evaluation, whereas three laparoscopic patients and one open patient died of causes not related to cancer. No wound recurrence was observed. The local recurrence rate after laparoscopic resection was 20.8%, as compared with 16.6% after open resection (p = 0.687). Distant metastases occurred in 18.2% of the patients in the laparoscopic group, as compared with 21.2% in the open group (p = 0.528). Cumulative survival probability was 0.709 after laparoscopic resection after LR and 0.606 after open resection (p = 0.162), whereas for Dukes’ stages A, B, and C in the laparoscopic group versus the open group, it was 0.875 vs 0.889 (p = 0.392), 0.722 vs 0.584 (p = 0.199), and 0.500 vs 0.417 (p = 0.320), respectively. At this writing 20 laparoscopic patients (62.5%) and 20 open patients (60.6%) are disease free (p = 0.623). Conclusions: Oncologic surgical principles were respected. Long-term outcome after laparoscopic resection of rectal cancer was comparable with that after conventional resection. We should wait to draw conclusive scientific statements until the completion of ongoing international radomized controlled trials.