Laparoscopy for Rectal Cancer

Atallah, Chady; Efron, Jonathan E.

doi:10.1055/s-0036-1597316

Cited by 8 publications

(4 citation statements)

References 58 publications

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“…[ 23 ] After several decades’ development, laparoscopic techniques have been advanced greatly, and many shortcomings have been overcome. [ 14 24 ] What's more, surgeons’ experience accumulation and progress in learning-curve can make them more skilful when operating LAS. In recent years, some articles reported that the long-time survival outcome of LAS was not inferior to open surgery for RC.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic versus conventional open surgery in T4 rectal cancer: A case–control study

Zhang

et al. 2019

J Min Access Surg

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Background:Laparoscopic surgery (LAS) for T4 rectal cancer (RC) is still controversial. This study aims to compare LAS with conventional open surgery in patients with T4 RC.Patients and Methods:Patients undergoing laparoscopic or open curative resection for T4 RC from January 2010 to September 2014 in our hospital were enrolled. Patients’ clinicopathological characteristics and survival outcomes were collected and compared. All statistical analysis was performed using SPSS 22.0.Results:A total of 125 patients (39 open, 86 LAS) were included in this study finally. The baseline information between the two groups were comparable except that LAS group had a more anterior resection (P = 0.012) and less combined resection (P = 0.003). The results demonstrated that patients in LAS group had less blood loss (P < 0.001), smaller incision length (P < 0.001), faster time to first soft diet (P = 0.010) and less incidence of post-operative complications, although it was not significantly different (P = 0.063). In addition, the operative time was also comparable (P = 0.140) and the conversion rate was low (2/86). The 3-year overall survival (OS) was 71.8%, 79.1% in open, LAS group respectively and the 3-year disease-free survival (DFS) was 66.7%, 68.6% in open, laparoscopic group, respectively. The Kaplan curves demonstrated that there was no significant difference between the two groups in OS (P = 0.981) or DFS (P = 0.900).Conclusions:LAS is safe and feasible in selected patients with T4 RC. It can achieve a better perioperative outcomes, and the long-time survival is not inferior to open surgery. Prospective studies should be conducted in the future to reduce the selection bias.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic versus conventional open surgery in T4 rectal cancer: A case–control study

Zhang

et al. 2019

J Min Access Surg

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“…There is an on-going debate about the use of laparoscopic proctectomy for rectal cancer. Several randomized trials have shown that shortterm outcomes and perioperative morbidity and mortality of laparoscopic proctectomy in the management of rectal cancer are equivalent to open surgery [13]. Preservation of Denonvilliers' fascia during laparoscopic resection for mid-low rectal cancer effectively protects male urinary and sexual functions [14].…”

Section: Discussionmentioning

confidence: 99%

A New Technique for Safe and Nerve Preserving Total Mesorectal Excision

Kirov

2018

Journal of Biomedical and Clinical Research

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Summary Our purpose was to present a technique of pneumodissection applied with total mesorectal excision that ensured effective pelvic nerve preservation. Its detailed description emphasized the role of the proper definition of optimal dissection plane around the rectal cancer, the so-called ‘holy plane’ for total mesorectal excision. The study covered 28 rectal cancer patients at a mean age of 58±7.6 years (range 53 to 69 years). Rectal cancers were of TNM stages I-III and differentiation grades of G1-G3. Total mesorectal excision with pneumodissection between 2011 and 2016 was performed. Inflation of the pararectal space with CO2 improved visualization of the operative field between visceral and parietal fascia thus preserving plexus (pl.) vesicalis, pl. deferentialis, pl. prostaticus and pl. cavernosus penis. A fast and clean mesorectum mobilization was made without any damage to the visceral fascia, and total mesorectal excision was performed in the embryonal plane. Pl. hypogastricus superior in the region of the aortic bifurcation nervi (nn.) hypogastrici dextri et sinistri laterally to the rectum and pl. hypogastricus inferior were preserved, too. Encouraging postoperative results included pelvic nerve preservation and absence of complications. A broader application of the safe method of pneumodissection in open and laparoscopic rectal cancer surgery should be recommended.

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“…Moreover, laparoscopic surgery can be performed safely in the elderly population, and reduce their pain and convalescence [2]. Therefore, laparoscopic technology has been routinely used in abdominoperineal excision (APE) in patients with distal rectal cancer [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic extralevator abdominoperineal excision in distal rectal cancer patients: a retrospective comparative study

et al. 2022

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Background At present, abdominoperineal excision with neoadjuvant chemoradiotherapy (nCRT) is one of the treatment modalities of distal rectal cancer. Our study analyzed the effects of laparoscopic extralevator abdominoperineal resection (ELAPE) compared with laparoscopic conventional abdominoperineal resection(cAPR) in the treatment of distal rectal cancer. Methods Retrospective analysis was conducted on the clinicopathological data of 177 distal rectal cancer patients treated with a laparoscopic abdominoperineal resection between 2011 and 2018. The patients were divided into four groups as follows: ELAPE without nCRT (group A), cAPR without nCRT (group B), ELAPE with long-course nCRT (group C) and cAPR with long-course nCRT (group D). Results Positive circumferential resection margin (CRM), local recurrence rate, 3-year disease-free survival (DFS) and 3-year overall survival (OS) did not differ between group A and group B. The rate of positive CRM in group C was lower than group D (4.4% vs. 11.9%, respectively), although the difference was not significant (P = 0.377). The 3-year local recurrence rate in group C was lower compared with group D (6.6% vs. 16.7%, respectively), although the difference was not significant (P = 0.135). Three-year DFS and 3-year OS were not different between groups C and D. Conclusions This study showed that the effect of laparoscopic ELAPE in patients with low-risk rectal cancer is similar to laparoscopic cAPR, revealing that laparoscopic cAPR can be routinely selected for patients with low-risk rectal cancer. Furthermore, laparoscopic ELAPE has a tendency to reduce the rate of positive CRM and local recurrence in patients with high-risk rectal cancer. Laparoscopic ELAPE can be routinely considered for patients with high-risk rectal cancer.

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Laparoscopy for Rectal Cancer

Cited by 8 publications

References 58 publications

Laparoscopic versus conventional open surgery in T4 rectal cancer: A case–control study

Laparoscopic versus conventional open surgery in T4 rectal cancer: A case–control study

A New Technique for Safe and Nerve Preserving Total Mesorectal Excision

Laparoscopic extralevator abdominoperineal excision in distal rectal cancer patients: a retrospective comparative study

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