Page 21 - Laparoscopic Surgery Online Journal

WJOLS

Laparoscopic vs Open Total Mesorectal Excision for Rectal Cancer: A Clinical Comparative Study

Table 1: Patients characteristics in laparoscopic or open
resection group
LAP resection Open resection
group (40) group (30)
1. Age (yrs) 52 ± 8 54 ± 7
2. Male:Female 17:23 14:16
3. ASA score 2 2
4. Preoperative CEA 3.4 4.2
5. Location of tumor
• Lower rectum 8 6
• Upper rectum 14 10
• Mid rectum 18 14
6. Grade of differentiation
• Well 14 10
• Moderately 20 12
• Poor 6 8
Fig. 5: Covering loop ileostomy
Table 2: Intra- and postoperative results
than in conventional surgery group (Table 2). Five patients
LAP resection Open resection
needed conversion to open surgery in laparoscopic resection group (40) group (30)
group, two because of advanced disease and the other three 1. Mean operative 200 150
because of dense adhesions. time (mins)
2. Mean blood loss (ml) 200 800
Postoperative complications were more frequent in the
3. Diverting ileostomy 30 15
open resection group than in LAP resection group. The 4. Conversion 5 –
passage of flatus occurred earlier in laparoscopic resection 5. Mean length of
hospital stay (days) 7 10
group, and oral intake could be started earlier in the LAP
6. Mean oral intake (days) 3 5
resection group. Mean postoperative stay was shorter in LAP
resection group than in open resection group.
To assess the adequacy of oncological resection, several Table 3: Histopathological evaluation of the resected specimens
parameters were examined from pathology reports. LAP resection Open resection
group (40) group (30)
Evaluation of the resected specimens is summarized in
1. Lymph nodes harvested 12 ± 3 9 ± 2
Table 3. The mean number of lymph nodes removed in LAP
2. Resected bowel (cm)
or open resection group was 12 ± 3 and 9 ± 2, respectively. LAR 21 26
No significant difference was found between the 2 groups. APR 27.5 32
3. Distal resection 3.7 3.5
The average lengths of removed specimens with the two
margin (cm)
surgical procedures were also comparable. Tumor distances
from the closest margin were similar too for the two
procedures, and were adequate from an oncological Table 4: The complications of the two groups
standpoint of view. Histological examination revealed that LAP resection Open resection
group (40) group (30)
proximal and distal margins were free of tumor in all surgical
specimens in both groups. The complications in the two 1. Ureter injury 1 1
2. Rectum perforation 0 1
groups are shown in Table 4. 3. Wound infection 1 6
4. Perineum infection 1 6
DISCUSSION 5. Anastomotic leak 1 2
6. Paralytic ileus 0 5
Laparoscopic techniques have been attempted and applied 7. Urinary retention 1 3
to wide range of colorectal disease since, first published 8. Recurrence
– Port site 0 –
10
study of laparoscopic colectomy in 1991 by Jacobs et al. – Local 1 3
After almost 20 years of clinical application, use of – Distant 2 3
laparoscopy for treatment of colorectal cancer is still
controversial because long-term outcome in malignancy is inaccuracies or possibility that use of pneumoperitoneum
7
of overwhelming importance compared with potential altered the patterns of tumor dissemination. Many questions
benefits obtained in the early postoperative course and have arisen concerning the oncological safety of this
11
advantages in cosmesis. There were serious concerns about approach, following reports on port site metastases. 12-14 In
potential inadequacy of resection, possible staging nonrandomized comparative studies, laparoscopic and open
World Journal of Laparoscopic Surgery, September-December 2013;6(3):127-131 129