Laparoscopic versus Open Total Mesorectal Excision: A Nonrandomized Comparative Prospective Trial in a Tertiary Center in Mexico City

Abstract

Because definitive long-term results are not yet available, the oncologic safety of laparoscopic surgery in rectal cancer remains controversial. Laparoscopic total mesorectal excision (LTME) for rectal cancer has been proposed to have several short-term advantages in comparison with open total mesorectal excision (OTME). However, few prospective randomized studies have been performed. The main purpose of our study was to evaluate whether relevant differences in safety and efficacy exist after elective LTME for the treatment of rectal cancer compared with OTME in a tertiary referral medical center. This comparative nonrandomized prospective study analyzes data in 56 patients with middle and lower rectal cancer treated with low anterior resection or abdominoperineal resection from November 2005 to November 2007. Follow-up was determined through office charts or direct patient contact. Statistical analysis was performed using χ2 test and Student's t test. Twenty-eight patients underwent LTME and 28 patients were in the OTME group. No conversion was required in the LTME group. Mean operating time was shorter in the laparoscopic group (LTME) (181.3 vs 206.1 min, P < 0.002). Less intraoperative blood loss and fewer postoperative complications were seen in the LTME group. Return of bowel motility was observed earlier after laparoscopic surgery. There was no 30-day mortality and the overall morbidity was 17 per cent in the LTME group versus 32 per cent in the OTME group. The mean number of harvested lymph nodes was greater in the laparoscopic group than in the OTME group (12.1 ± 2 vs 9.3 ± 3). Mean follow-up time was 12 months (range 9-24 months). No local recurrence was found. LTME is a feasible procedure with acceptable postoperative morbidity and low mortality, however it is technically demanding. This series confirms its safety, although oncologic results are at present comparable with the OTME published series with the limitation of a short follow-up period. Further randomized studies are necessary to evaluate long-term clinical outcome.

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

“…An additional problem associated with the use of laparoscopic surgery for the lymph nodes, length of specimen and surgical margins) did not differ significantly between those who underwent laparoscopic surgery and those who underwent open resection, in the present study. This finding is supported by randomized trials that demonstrated an equal or greater extent of resection in laparoscopic surgery 10,22 and suggests that oncological treatment principles are not compromised by laparoscopic techniques.…”

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

“…From the 253 titles identified through the primary search, 71 were excluded following abstract review. A further 85 studies were then excluded following full‐text review, leaving a total of 97 studies eligible for inclusion in the study and which went on to data extraction and analysis (Table ).…”

Propensity Score-Matched Analysis of Laparoscopic versus Open Surgery for Non-Metastatic Rectal Cancer

“…In a prospective comparative study including 56 patients, Gonzalez et al (González et al, 2009) :10.31557/APJCP.2021.22.12.3967 Propensity Score-Matched Lap vs Open (Ströhlein et al, 2008). Besides, fewer LNs were reported to be associated with a short surgical specimen length and neoadjuvant treatment in rectal cancer patients (Stracci et al, 2016).…”

“…Several studies have suggested that laparoscopic surgery could achieve the same effectiveness as open surgery concerning LN harvesting (Wu et al, 2012;Lujan et al, 2013;Zhou et al, 2015;Stracci et al, 2016;Balducci et al, 2017). Two studies reported greater LN harvesting using the LR approach compared to the OR approach (González et al, 2009;Boutros et al, 2013). In a retrospective comparative study involving (range, 8-18) following TME.…”