Page 19 - Laparoscopic Surgery Online Journal

WJOLS
10.5005/jp-journals-10033-1197
Laparoscopic vs Open Total Mesorectal Excision for Rectal Cancer: A Clinical Comparative Study
ORIGINAL ARTICLE
Laparoscopic vs Open Total Mesorectal Excision for
Rectal Cancer: A Clinical Comparative Study in

a Government Sector Hospital

Manash Ranjan Sahoo, T Anil Kumar, Sunil Jaiswal

ABSTRACT patients– and possibly a less radical resection. Moreover,
the increased use of coloanal anastomosis has also increased
Aims and objectives: To assess feasibility, advantages,
oncological safety, cost-effectiveness and short-term results the need for better visualization during pelvic dissection.
of laparoscopic vs open total mesorectal excision (TME) for The laparoscopic approach to rectal cancer may be an
rectal cancer in a government sector hospital.
attractive alternative for open TME because it offers better
Patients and methods: This comparative nonrandomized visualization, more delicate instrumentation and better tissue
retrospective study analyzes the data of 70 patients with rectal handling. This in turn, may lead to an adequate dissection
cancer treated with low anterior resection (LAR) or abdomino-
perineal resection (APR) from May 2007 to June 2012. Of these up to the pelvic floor in combination with a better
40 patients underwent laparoscopic TME and 30 underwent preservation of the hypogastric plexus and erigent nerves,
open TME. Both the groups were comparable.
possibly resulting in an improved functional and oncological
Results: Laparoscopic surgery took longer to perform (200 vs outcome.
150 min), but was accompanied by less blood loss (200 vs Several recently published randomized studies have
800 ml) and fewer postoperative complications. Enteric function
recovered sooner after laparoscopy than open surgery.Hospital shown short-term benefits of the laparoscopic approach to
stay was shorter for patients who underwent a laparoscopic colon cancer over the open approach, without compromising
surgery (7 vs 10 days). The mean number of harvested lymph oncological outcome. 6-9 Hence, we performed a study to
nodes was greater in the laparoscopic group than in the open
compare laparoscopic TME with open TME in terms of
group (12 ± 3 vs 9 ± 2). Mean follow-up time was 30 months
(range: 28-32 months). No local recurrence was found. perioperative and short-term outcomes in patients with rectal
cancer in government sector hospital SCB Medical College,
Conclusion: This study shows that laparoscopic TME for rectal
cancer is a safe and feasible technique with some short-term Cuttack.
benefits over open TME.
PATIENTS AND METHODS
Keywords: Total mesorectal excision, Low anterior resection,
Abdominoperineal resection.
Seventy patients undergoing low anterior resection and
How to cite this article: Sahoo MR, Kumar TA, Jaiswal S. abdominoperineal resections for rectal carcinoma between
Laparoscopic vs Open Total Mesorectal Excision for Rectal May 2007 and June 2012 at SCB Medical College and
Cancer: A Clinical Comparative Study in a Government Sector
Hospital. World J Lap Surg 2013;6(3):127-131. Hospital (Cuttack, Orissa, India) were entered into a
database. Of these 40 patients underwent laparoscopic
Source of support: Nil
resection and 30 conventional open resection.
Conflict of interest: None Exclusion criteria were:
1. Presence of distant metastasis
INTRODUCTION
2. Locally advanced disease with invasion into adjacent
Since its introduction in 1982, the total mesorectal excision pelvic organs
1
(TME) concept by Heald et al has become the gold standard 3. Acute bowel obstruction or perforation from cancer
in surgical treatment of rectal cancer. 2,3 It includes the 4. Severe medical illness.
standard excision of the total mesorectum, through the All patients received the same pretreatment workup,
avascular ‘holy plane’, removing potential micrometastases including an ultrasound, colonoscopy with biopsies, chest
enclosed in the mesorectum. At present, TME in X-ray and carcinoembryonic antigen (CEA) level for
combination with preoperative radiation therapy offers the dissemination status. CECT abdomen was routinely done
lowest local recurrence rate (5%) and the highest 5-year to rule out metastatic disease and to look for evidence of
survival rate (80%) in patients with mid- and low-rectal local infiltration, gauge the size of tumor and regional lymph
cancer. 4,5 node involvement.
There are however problems with open TME surgery, All patients received mechanical bowel preparation day
mainly pertaining to difficulties in pelvic dissection, often before the operation. Systematic prophylactic antibiotics
leading to functional urogenital problems–especially in male were given intravenously at the time of induction.
World Journal of Laparoscopic Surgery, September-December 2013;6(3):127-131 127