Comparison of Clinical Outcomes of Laparoscopic Assisted Vs Open Surgery for Rectal Cancers- A Retrospective Study

Title: Comparison of Clinical Outcomes of Laparoscopic Assisted Vs Open Surgery for Rectal Cancers- A Retrospective Study

Authors: Dr Akshay H Nerlekar, Dr N J Gadekar, Dr J M Gadekar

DOI: https://dx.doi.org/10.18535/jmscr/v5i2.128

Abstract

Introduction: Rapidly developed technique in rectal surgery is the laparoscopic procedure. In this investigation aim is to assess the distinctiveness of short-term and medium-term clinical outcomes of laparoscopic-assisted versus open surgery for rectal cancer.

Methods: Patients with non-metastatic rectal cancer were enrolled for this study. They were 51 in number. The patients underwent either laparoscopic-assisted surgery (LAP) (n = 25) or open surgery (OP)(n = 26). Surgical techniques, perioperative managements and clinical follow-ups were standardized. Short-term perioperative data, medium-term clinical outcomes &survival were compared and analysed between the two groups.

Results: No differences were found in perioperative parameters between the two groups except that there was a trend of faster recovery in laparoscopic procedures. Statistically there was no significant difference in postoperative complications, re operation rate, or perioperative mortality. There was statistically significant difference in a faster return of gastrointestinal function and shorter hospital stay which were identified in favour of laparoscopic-assisted resection. In all rectal cancer cases, the overall survival, cancer-free survival and recurrence rate were same in two groups. No tendency of significant differences in overall survival, cancer-free survival and recurrence in stage I-II and stage III patients in two cancer categories between the two groups, respectively.

Conclusions: In the treatment of non-metastatic rectal cancer, Laparoscopic-assisted procedure has more benefits on postoperative recovery, medium-term clinical outcomes &survival as compared with open surgery.

References

1. NCCN clinical practice guidelines oncology. [http://www.nccn.org/professionals/physician_gls/f_guidelines.asp].

2. Bokey EL, Chapuis PH, Dent OF, Newland RC, Koorey SG, Zelas PJ, Stewart PJ: Factors affecting survival after excision of the rectum for cancer, a multivariate analysis. Dis Colon Rectum 1997, 40:3-10.

3. Jacobs M, Verdeja JC, Goldstein HS: Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1991, 1:144-150.

4. Sekimoto M: Laparoscopic resection for colorectal cancer in Japan. Dis Colon Rectum 2007, 50:1708-14.

5. Tomita H, Marcelo PW, Milsom JW: Laparoscopic surgery of the colon and rectum. World J Surg 1999, 23:397-405.

6. Joo JS, Amarnath L, Wexner SD: Is lapar-oscopic resection of colorectal polyps beneficial? Surg Endosc 1998, 12:1341-1344.

7. Liberman MA, Phillips FH, Carroll BJ, Fallas M, Rosenthal R: Laparoscopi-c colectomy vs traditional colectomy for diverticulitis. Surg Endosc 1996,10:15-18.

8. Young-Fadok TM, Hall LK, McConnell EJ, Gomez Rey G, Cabanela RL: Advantages of laparoscopic resection for ileocolic Crohn’s disease. Surg Endosc 2001, 15:450-454.

9. Takeuchi I, Ishida H, Mori T, Hashimoto D: Comparison of the effects of gasless procedure, CO₂-pneumoperitoneum and laparotomy on splenic and hepatic natural killer activity in a rate model. Surg Endosc 2004, 18:255-260.

10. Curet MJ: Laparoscopic-assisted resection of colorectal carcinoma. Lancet2005, 365:1666-1668.

11. Motson RW: Laparoscopic surgery for colorectal cancer. Br J Surg 2005,92:519-520.

12. Pascual M, Alonso S, Parés D, Courtier R, Gil MJ, Grande L, Pera M:Randomized clinical trial comparing inflammatory and angiogenic response after open versus laparoscopic curative resection for colonic cancer. Br J Surg 2011, 1:50-59.

13. Tan KY, Konishi F: Long-term results of laparoscopic colorectal cancer resection: current knowledge and what remains unclear. Surg Today 2010, 40:97-101.

14. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group: 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.

15. Veldkamp R, Kuhry E, Hop WC, Kazemier G, Bonjer HJ, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy AM, COlon cancer Laparoscopic or Open Resection Study Group (COLOR): Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial.Lancet Oncol 2005, 6:477-484.

16. Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G, Clinical Outcomes of Surgical Therapy (COST) Study Group: Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer. JAMA 2002, 287:321-328.

17. COLOR Study Group: COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer. Dig Surg 2000,17:617-622.

18. Hazebroek EJ, Color Study Group: COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer. Surg Endosc 2002, 16:949-953.

19. Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J: Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet2002, 359:2224-2229.

20. Lacy AM, Garcia-Valdecasas JC, Pique JM, Delgado S, Campo E, Bordas JM, Taurá P, Grande L, Fuster J, Pacheco JL, Visa J: Short-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer. Surg Endosc 1995, 9:1101-1105.

21. Dickersin K, Scherer R, Lefebvre C: Identifying relevant studies for systematic reviews. BMJ 1994, 309:1286-1291.

22. The Clinical Outcomes of Surgical Therapy (COST) Study Group: A compari-son of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004, 350:2050-1059.

23. Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr,Hellinger M, Flanagan R Jr, Peters W, Nelson H, for The Clinical Outcomes of Surgical Therapy Study Group: Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 2007, 246:662-664.

24. Leung KL, Kwok SP, Lam SC, Meng WC, Yiu RY, Lee JF, Lau WY:prospective randomizedLancet 2004, 363:1187-1192.

25. Kitano S, Kitajima M, Konishi F, Kondo H, Satomi S, Shimizu N, Japanese Laparoscopic Surgery Study Group: A multicenter study on laparoscopic surgery for colorectal cancer in Japan. Surg Endosc 2006, 20:1348-1352.

26. Zhou ZG, Hu M, Lei WZ, Lei WZ, Yu YY, Cheng Z, Li L, Shu Y, Wang TC:Laparoscopic versus open total mesorectal excision with anal sphincter pre servation for low rectal cancer. Surg Endosc 2004, 18:121-125.

27. Kitano S, Inomata M, Sato A, Yoshimura K, Moriya Y, Japan Clinical Oncology Group Study: Randomized controlled trial to evaluate laparoscopic surgery for colorectal cancer: Japan Clinical Oncology Group Study JCOG 0404. Jpn J Clin Oncol 2005, 35:475-477.

28. Gendall KA, Kennedy RR, Watson AJ, Frizelle FA: The effect of epidural ana-lgesia on postoperative outcome after colorectal surgery. Colorectal Dis 2007, 9:584-98, discussion 598-600.

29. Senagore AJ, Delaney CP, Mekhail N, Dugan A, Fazio VW: Randomized clinical trial comparing epidural anaesthesia and patient-controlled analgesia after laparo-scopic segmental colectomy. BrJ Surg 2003,90:1195-1199.

30. Noel JK, Fahrbach K, Estok R, Cella C, Frame D, Linz H, Cima RR, Dozois EJ, Senagore AJ: Minimally invasive colorectal resection outcomes short-term comparison with open procedures. J Am Coll Surg 2007,204:291-307.

31. Hewett PJ, Allardyce RA, Bagshaw PF, Frampton CM, Frizelle FA, Rieger NA, Smith JS, Solomon MJ, Stephens JH, Stevenson AR: Short-Term Outcomes of the Australasian Randomized Clinical Study Comparing Laparoscopic and Conventional Open Surgical Treatments for Colon Cancer: the ALCCaS trial. Ann Surg 2008, 248:728-738.

32. Casillas S, Delaney CP, Senagore AJ, Brady K, Fazio VW: Does conversion of a laparoscopic colectomy adversely affect patient outcome? Dis Colon Rectum 2004, 47:1680-1685.

33. Gonzalez R, Smith CD, Mason E, Duncan T, Wilson R, Miller J, Ramshaw BJ:Consequences of conversion in laparoscopic colorectal surgery. Dis Colon Rectum 2006, 49:197-204.

34. Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J: Laparoscopy-assisted colectomy versus opencolectomy for treatment of non-metastatic colon cancer: a randomized trial. Lancet2002, 359:2224-2229.

35. Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, Heath RM, Brown JM, UK MRC CLASICC Trial Group: Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 2007, 25:3061-3068.

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Abstract

Call For Paper Volume 12 Issue 12 December 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles