Long-Term Morbidity and Oncologic Outcomes of Laparoscopic-Assisted Anterior Resection for Upper Rectal Cancer

Ng, Simon; Leung, Ka Lau; Lee, Janet F. Y.; Yiu, Raymond Y. C.; Li, Jimmy C. M.; Hon, Sophie S. F.

doi:10.1007/dcr.0b013e31819ec20c

Cited by 155 publications

(211 citation statements)

References 25 publications

(27 reference statements)

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“…The findings of this study are similar to those in other reports4 15. One15 of these studies reported that after 10 years the need for further operation for adhesive SBO was 7 per cent (5 of 74 patients) following open rectal resection versus 0 per cent (0 of 74) after laparoscopic surgery.…”

Section: Discussionsupporting

confidence: 90%

“…One15 of these studies reported that after 10 years the need for further operation for adhesive SBO was 7 per cent (5 of 74 patients) following open rectal resection versus 0 per cent (0 of 74) after laparoscopic surgery. The other report4 examined the risk of surgery for SBO including adhesive SBO following rectal resection in a Swedish population‐based study.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies4 7, 8, 9, 10 have suggested an advantage for laparoscopic surgery, whereas others11, 12, 13, 14 have found no difference in the risk of adhesive SBO after open or laparoscopic surgery. Only two studies4 15 have compared the risk of surgery for adhesive SBO following laparoscopic or open rectal surgery. Both suggested an advantage for laparoscopic surgery.…”

Section: Introductionmentioning

confidence: 99%

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Nationwide population-based cohort study to assess risk of surgery for adhesive small bowel obstruction following open or laparoscopic rectal cancer resection

et al. 2017

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BackgroundLaparoscopic surgery has been reported to reduce the formation of adhesions following colorectal surgery. The aim of this nationwide cohort study was to investigate the risk of surgery for adhesive small bowel obstruction (SBO) following open and laparoscopic rectal cancer resection.MethodsPatients undergoing rectal cancer resection between 2005 and 2013 were identified in the Danish Colorectal Cancer Group database. The primary outcome of surgery for adhesive SBO was identified in the Danish National Patient Registry. The risk of surgery for adhesive SBO was estimated as the cumulative incidence proportion, treating death as a competing risk. Cox proportional hazards regression analysis with multivariable adjustment was used to compute hazard ratios (HRs). The secondary outcome was 30‐day mortality after surgery for adhesive SBO.ResultsOf 7657 patients, 340 (4·4 per cent) underwent surgery for adhesive SBO. The 5‐year risk of surgery for adhesive SBO was 4·5 per cent among 4472 patients undergoing open resection and 3·0 per cent among 3185 patients having a laparoscopic resection. Laparoscopic rectal resection was associated with a lower risk of subsequent operation for adhesive SBO (adjusted HR 0·65, 95 per cent c.i. 0·50 to 0·86; P = 0·002). The adjusted HR of mortality after adhesive SBO was 0·84 (0·37 to 1·91; P = 0·671) comparing patients with previous laparoscopic and open resection.ConclusionLaparoscopic rectal cancer resection was associated with a decreased risk of surgery for adhesive SBO. There was a substantial difference in 30‐day mortality after surgery for adhesive SBO based on the surgical approach used at the time of rectal resection.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Nationwide population-based cohort study to assess risk of surgery for adhesive small bowel obstruction following open or laparoscopic rectal cancer resection

et al. 2017

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“…Evidence comes mainly from several case series [4,[10][11][12], comparative nonrandomized studies [13][14][15], or randomized clinical trials (RCTs) [16][17][18][19][20][21] with a limited number of patients or a relatively short follow-up period.…”

Section: Discussionmentioning

confidence: 99%

Metastatic lymph node ratio as a prognostic factor after laparoscopic total mesorectal excision for extraperitoneal rectal cancer

et al. 2012

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BackgroundThe lymph node ratio (LNR; number of positive nodes divided by total nodes harvested) has been demonstrated to be a prognostic factor in colon cancer, but its role in extraperitoneal rectal cancer is still debated; furthermore, no data are available on laparoscopic rectal resection. The aim of this study was to evaluate the prognostic impact of LNR on long-term outcomes after laparoscopic total mesorectal excision (LTME) for extraperitoneal cancer in consecutive patients with a 5-year minimum follow-up. Methods This study is a prospective analysis of consecutive patients who underwent LTME for adenocarcinoma of the extraperitoneal rectum. Results LTME was performed in 158 patients. The median number of LN harvested was 12 (range = 3-25). The proportion of specimens with fewer than 12 examined LN was significantly higher in patients who had neoadjuvant chemoradiotherapy (p < 0.001). During a median follow-up period of 122 months, the local recurrence rate was 8 %. At univariate analysis, disease-free survival and overall survival significantly decreased with increasing LNR (p < 0.001). Multivariate analysis showed that the distal margin ≤1 cm was the only independent predictor of local recurrence (p = 0.028). LNR (cutoff value = 0.25) and lymphovascular invasion were significant prognostic factors for both disease-free (p = 0.015 and p = 0.046, respectively) and overall survival (p = 0.031 and p = 0.040, respectively). Even in the subgroup of patients in whom fewer than 12 LN were examined, LNR confirmed its prognostic role, with a statistical trend toward worse disease-free survival and overall survival. Conclusion Metastatic LNR is an independent prognostic factor for disease-free survival and overall survival after LTME for extraperitoneal rectal cancer. Keywords Lymph node ratio Survival Laparoscopy Total mesorectal excision Rectal cancer Excellence of surgical technique is of particular relevance in the treatment of extraperitoneal rectal cancer. Routine excision of the intact mesorectum during resection of cancer of the middle and lower rectum has resulted in a significant decrease in local recurrence rates [1]. Developed and popularized by Heald and co worker [1], total mesorectal excision (TME) is presently the surgical gold standard, with a 4 % local recurrence rate and a 78 % tumor-free survival rate in curative cases at 5 years [2]. A recent meta-analysis by Huang et al. [3] of randomized controlled trials that included small numbers of patients with upper or mid-to-low rectal cancer did not show differences between laparoscopic and open surgery in terms of the number of lymph nodes (LN) harvested, local recurrence, 3-year disease-free survival, and overall survival. Although a minimum of 12 LN in the

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“…По мере увеличения числа выполенных лапа-роскопических операций при колоректальном раке были получены данные об отдаленных результатах: при соблюдении онкологических принципов хи-рургии не выявлены достоверные различия между показателями выживаемости, частотой отдаленных метастазов и качеством жизни после лапароскопи-ческих и открытых вмешательств [1,[4][5][6][7][8][9][10]. Много-центровые исследования демонстрируют эффек-тивность лапароскопических вмешательств, сопо-ставимую с традиционной «открытой» хирургией на основании оценки отдаленных результатов и уровня качества жизни [6].…”

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Laparoscopic hand-assisted combined access in surgeries for left colon and rectum in patients with complex surgical anatomy

Hitaryan¹,

Prazdnikov²,

Glumov³

et al. 2016

Endosk. khir.

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Long-Term Morbidity and Oncologic Outcomes of Laparoscopic-Assisted Anterior Resection for Upper Rectal Cancer

Abstract: Laparoscopic-assisted anterior resection for upper rectal cancer is associated with fewer long-term complications and similar ten-year oncologic outcomes when compared with open surgery.

Cited by 155 publications

References 25 publications

Nationwide population-based cohort study to assess risk of surgery for adhesive small bowel obstruction following open or laparoscopic rectal cancer resection

Nationwide population-based cohort study to assess risk of surgery for adhesive small bowel obstruction following open or laparoscopic rectal cancer resection

Metastatic lymph node ratio as a prognostic factor after laparoscopic total mesorectal excision for extraperitoneal rectal cancer

Laparoscopic hand-assisted combined access in surgeries for left colon and rectum in patients with complex surgical anatomy

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