Have early postoperative complications from laparoscopic rectal cancer surgery improved over the past 20 years?

Abstract

There was no evidence of a statistically significant change in early postoperative complications until 3 years ago. This may reflect the inherent morbidity associated with rectal surgery regardless of the approach used, the limitations of the current laparoscopic instrumentation or the relatively long learning curve. With increasing experience, a repeat analysis in the near future following the publication of ongoing randomized clinical trials might show improved outcomes.

Non-surgical complications after laparoscopic and open surgery for colorectal cancer − A systematic review of randomised controlled trials

“…11,40 Despite recent technologic advances and increased surgeon experience in minimally invasive techniques, a significant improvement in the postoperative complication rate for colorectal surgery is still lacking. 2,3,40,41 Non-surgical morbidity has been identified as a potential target for further improvements.…”

“…11,40 Despite recent technologic advances and increased surgeon experience in minimally invasive techniques, a significant improvement in the postoperative complication rate for colorectal surgery is still lacking. 2,3,40,41 Non-surgical morbidity has been identified as a potential target for further improvements. 14,19 Although no useful comparisons could be made for some non-surgical adverse events, our systematic review demonstrates a decrease in cardiac morbidity following laparoscopic surgery for colon cancer.…”

“…One reason could be that rectal surgery is generally more extensive and associated with an inherently higher overall morbidity rate. 11,40 Furthermore, studies have demonstrated that operative duration is associated with an increased risk of cardiopulmonary complications. 45,47 Since the duration of total mesorectal excision is generally more prolonged when compared to colectomy and laparoscopic techniques prolong the duration of surgery even further, 11,13 the benefits of laparoscopic surgery may be less apparent for rectal cancer.…”

Outcomes following laparoscopic rectal cancer resection by supervised trainees

“…Patients with anaesthetic problems had difficulties with ventilation or cardiac ischaemia and, compared with the other two groups, were more obese, required a longer incision and had an increased hospital stay ( Table 2). The oncological reasons for conversion were contiguous organ involvement in the pelvis (6 patients) or locally advanced tumour in a narrow pelvis (3). Technical reasons for conversion varied; adhesions were implicated in many, and other diverse issues included a fibroid uterus, staple gun misfiring and a narrow pelvis.…”

Time for a Renewed Strategy in the Management of Rectal Cancer

“…the fact that, despite 20 years of practice of lRs, there has been no clear trend of improvement in the rate of postoperative complications, indicates that other factors could be involved, such as limitations of the current laparoscopic instrumentation, an exceptionally long learning curve, or the association of rectal resection with inherent morbidity regardless of the approach used. 15 also, a systematic review of the studies reporting the use of the robotic approach for resection of rectal cancer failed to show a clear significant reduction in early postoperative complications when compared with standard laparoscopic surgery, with only potentially better short-term outcomes when applied in selected patients, such as obesity, male sex, preoperative radiotherapy, and tumors in the lower two thirds of the rectum. 14 on critical reflection, the findings in the currently available literature indicate the need for a renewed strategy in the surgical management of rectal cancer, because it is unlikely that further experience in lRs would result in improved short-term outcomes.…”