Comparison of hand-assisted laparoscopic surgery and conventional laparotomy for rectal cancer: Interim results from a single center

Abstract

Minimally invasive laparoscopic surgery has become widespread and the indications for such surgery have recently been extended to various conditions, including rectal cancer. The objective of this study was to compare the clinical outcome of hand-assisted laparoscopic surgery (HALS) and conventional laparotomy (CL) in patients with rectal cancer. Patients who underwent radical resection of stage I-III primary rectal cancer (n=111) were classified into those receiving HALS (n=57) and those receiving CL (n=54); the two groups were matched for stage and postoperative treatment. The 3-year relapse-free survival (3Y-RFS) and 3-year overall survival (3Y-OS) were calculated and compared between the two groups. Intraoperative blood loss, operating time, postoperative hospital stay and complications were also compared between the two groups. There were no significant differenceS in 3Y-RFS or 3Y-OS between the HALS and CL groups for patients with all-stage (I, II and III) rectal cancer. The mean (median) intraoperative blood loss was 344.0 (247.0) ML in the HALS group vs. 807.5 (555.5) ML in the CL group (P<0.001). The mean (median) postoperative hospital stay was 19.8 (17) and 25.5 (18.3) days, respectively (P=0.039). There were no significant differences in the operating time or the incidence of complications between the two groups. Based on these results, HALS was found to be comparable to CL regarding survival, while achieving less blood loss and a superior cosmetic outcome. However, longer follow-up is required to confirm these findings.

Laparoscopy in the Management of Colon Cancer

“…The long-term survival rate of colorectal cancer patients undergoing laparoscopic surgery compared to open surgery procedures is also analyzed. No statistical difference in 3-or 5-year OS and 3-or 5-year DFS between the two procedures was reported (P>0.05) [8].…”

“…In results from a single-center study from Tajima et al, patients were compared according to their age, gender, and tumor location between the hand-assisted laparoscopy (HALS) and CL groups [8] ( Table 2). Less bleeding during surgery, faster postoperative recovery, and shorter stay are some of numerous advantages of laparoscopic resection of colon.…”

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)(5)(6)(7)(8)(9)(10)(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.…”

“…For HALS, a small incision of 50 mm was created for hand access. In accordance with the JSCCR guidelines 2019 (2) and classification of colorectal carcinoma 17, central vascular ligation was conducted at the root of the inferior mesenteric artery as distal D3 lymph node dissection or left colic artery-preserving D2 ligation (17)(18)(19)(20). TME was conducted for rectosigmoid tumors by transection of the mesorectum immediately above the aortic bifurcation.…”

“…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.…”