Comparison of hand-assisted laparoscopic surgery (HALS) and conventional laparotomy in patients with colorectal cancer: Final results from a single center

Abstract

Abstract.In recent years, the use of laparoscopic surgery has been expanded to include radical curative resection. In a previous study, 212 patients with primary colorectal cancer (stages I-III) underwent radical curative resection by hand-assisted laparoscopic surgery (HALS) (n=98) or conventional laparotomy (CL) (n=114) and were compared with respect to 3-year relapse-free survival (3Y-RFS) and 3-year overall survival (3Y-OS). The study included 210/212 patients who were followed up to 5 years, including 96 patients who underwent HALS and 114 treated with CL. The two groups were matched for stage, clinical background, and postoperative management. Patient characteristics were compared and the 5Y-RFS and 5Y-OS were determined. The 5-year follow-up rate was 97.6%. In stage I-III patients, 5Y-RFS and 5Y-OS showed no significant differences between HALS and CL. The patients with stage I disease accounted for 41.7% (40/96) of the patients undergoing HALS, while stage I patients only accounted for 23.7% (27/114) of the patients undergoing CL, and the difference was significant (P= 0.005). Stage II patients undergoing CL were older than those treated with HALS (P=0.017). However, there were no differences in the characteristics of stage III patients undergoing HALS or CL. In conclusion, HALS achieved a similar survival to CL in patients with stage I to III colorectal cancer. Compared with CL, HALS was performed more safely and achieved superior cosmetic results. IntroductionIn recent years, the indications for laparoscopic surgery have been expanded to include radical curative resection of early to advanced colorectal cancer and palliative surgery for stage IV disease (1-6). In Japan, laparoscopy-assisted colorectal surgery (pure LACS) is widely used. However, pure LACS has several disadvantages, such as requiring at least 2 physicians who are familiar with the procedure and prolonging the operating time, as well as needing more staff and limiting the availability of operating theaters. Previously, it was reported that pure LACS achieves the same or better outcomes as conventional laparotomy (CL) with regard to wound infection, hospital stay, and survival, together with superior cosmetic results (7-10). In Europe and the USA, hand-assisted laparoscopic surgery (HALS) (HH) is more widely used than pure LACS. HH is characterized by: i) Providing the operator with palpation/tactile sensation, and allowing full grasping manipulation with the left hand and the possibility of smoothly removing even large and heavy tumors; ii) a shorter operating time than for pure LACS; and iii) a more rapid learning curve than for pure LACS (8,9,[11][12][13][14][15][16][17].In Japan, various surgical procedures are employed for colorectal cancer, including pure LACS (30-40%), CL (~50%), and other methods such as HALS and microincisional surgery (18). HALS is often regarded as being an optimal medium between CL and pure LACS (8,9,(18)(19)(20)(21)(22)(23). In Japan, HALS initially became popular for a short period of time during the introdu...

Pelvic local recurrence as first relapse predicts prognosis for clinical stage II/III lower rectal cancer: A clinicopathological investigation

“…These two reasons do not seem to add up at present ( 4-11 ). An alternative approach could be to control fatal hematogenous metastasis in the lung and liver, which may be more beneficial than reducing local recurrence in extending progression-free and overall survival rates ( 3 , 18 , 19 ). However, in the present study, the prognosis of the remote metastasis group was better than that of the local recurrence group.…”

“…However, for operating on advanced lower rectal cancer, complications relating to the dissection margin at the posterior and rectal side of the tumor have been observed using this technique ( 23 , 24 ). Accordingly, in 2007, we began developing HALS, a hybrid technique between standard laparotomy and full-endoscopic surgery, and have reported favorable outcomes ( 18 , 25 , 26 ). Three-port HALS for rectal cancer achieved better results than standard laparotomy ( 18 ).…”

“…Accordingly, in 2007, we began developing HALS, a hybrid technique between standard laparotomy and full-endoscopic surgery, and have reported favorable outcomes ( 18 , 25 , 26 ). Three-port HALS for rectal cancer achieved better results than standard laparotomy ( 18 ). Requiring only a small incision of approximately 50 mm, HALS is considered a sound technique, characterized by low invasiveness, low risk, low cost, and good outcomes.…”

“…Requiring only a small incision of approximately 50 mm, HALS is considered a sound technique, characterized by low invasiveness, low risk, low cost, and good outcomes. In addition, it places less burden on patients, doctors and hospitals than standard laparotomy ( 18 , 25 , 26 ). Three intra-operative factors can lower the rate of pelvic local recurrence: i) Maintaining a thick resection margin (>1 mm) around the tumor, which must be avoided so as not to disperse cancer cells into the intestine by perforating the tumor during surgery.…”

“…Lateral dissection was performed from the anterior sacrum to the medial region of the bilateral internal iliac artery. TME was also conducted from the anterior region of the pelvic floor muscles and from the lower part of the bladder to the posterior face of the prostate or the rear wall of the vagina ( 18 ). Patients with Ra rectal cancer underwent TSME.…”