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World Journal of Laparoscopic Surgery, September-December 2008;1(3):53-57
Laparoscopic Sugery for Rectal Carcinoma—An Experience of 20 Cases in a Government Sector Hospital
Laparoscopic Surgery for Rectal Carcinoma—

An Experience of 20 Cases in a Government

Sector Hospital

Ashok K Mathur, Sameer Gupta, Nisar Ahmed, Asit Arora, Akshay Sharma
Upgraded Department of General Surgery, Unit 4, SMS Medical College, Jaipur, Rajasthan
Correspondance: Sameer Gupta, Room No.175, Resident Doctors’ Hostel, SMS Medical College, Jaipur, Rajasthan
E-mail: Samsite@Indiatimes.com

Abstract INTRODUCTION

Objective: To assess feasibility, advantages, oncological safety, cost Laparoscopic techniques have been attempted and applied to
effectiveness and long term results of laparoscopic surgery for rectal wide range of colorectal disease since first published study of
cancer in a government sector hospital. laparoscopic colectomy in 1991 by Jacobs et al. From its initial
1
Method: From January 2005 to May 2007, 20 patients of operable use in treatment of benign lesions such as diverticulosis, polyps,
cancer rectum were subjected to laparoscopic curative resection. Surgical rectal prolapse and inflammatory bowel disease laparoscopic
technique, postoperative morbidity and clinical results were reviewed techniques are increasingly being applied for curative resection
in close follow-up for median period of 20 months (12 wks to 30 of colorectal cancer. Several advantages of laparoscopic
months). colorectal surgery have been reported, including reduction of
postoperative pain, shortened postoperative ileus, shortened
Results: Fourteen patients underwent LAPR and 6 patients LAR.
hospital stay, better cosmesis and favorable effects on cytokine
Median age was 39 years. Median operating time for Lap APR was and hormonal responses. 2
296 minutes, initial 7 cases taking an average of 368 minutes, while However, there were and still are strong reservations
subsequent 7 cases average operating time was 232.5 minutes. In Lap regarding laparoscopic rectal cancer surgery with focus on
AR, average duration of surgery was 356 minutes, first 4 cases taking inadequate oncologic resection and risk of tumor cell spillage
400 minutes while for last 2 cases, and mean operating time was because of traumatic manipulation of tumor, putting patients at
300 min.
risk of developing early recurrences. Also laparoscopic colorectal
There was no intraoperative complication in either group. All surgery entails a long and steep learning curve for the surgeon.
patients mobilized on POD: (1) Incidence of PONV was significantly However in a number of recent studies, laparoscopic and
less. Oral feeds were routinely started on POD, (2) Incidence of wound open excision of rectal cancer were found to be equivalent in
infection was also reduced (2/20). Hospital stay on an average was 11 achieving clear distal and radial margins, extent of resection, i.e.
days as ours being a government sector hospital, patients were number of lymph nodes sampled, length of bowel and mesentery
discharged only after drain removal and thus stay was slightly resected and bowel margins did not differ significantly between
prolonged. Of the 20 patients, 17 were diagnosed to be Adenocarcinoma,
2 with Malignant Melanoma and 1 with GIST. Two patients of lap and open groups with satisfactory oncological control and
malignant melanoma developed locoregional recurrence and 2 patients functional outcomes.
developed distant metastasis after approximately 1 year. No incidence We describe our experience with laparoscopic resection of
of port metastasis in any patient. rectosigmoid carcinoma in 20 patients in a Government sector
hospital.
Conclusion: Laparoscopic colorectal surgery is safe, feasible and meets
oncologic requirements of radicality. Pattern of local recurrence and PATIENTS AND METHODS
distant metastasis is similar to open surgery. Lap surgery has a steeper
learning curve. Cost of treatment decreased by use of Ligaclips for From January 2005 to May 2007, 20 patients diagnosed to have
intracorporeal vascular control and extracorporeal division of gut rectosigmoid and rectal carcinoma, admitted in SU-IV of SMS
whenever possible. Hospital, Jaipur were selected to undergo laparoscopic curative
Keywords: Rectal carcinoma; laparoscopy; anterior resection; abdo- resection. Of these, 7 patients underwent lap anterior resection
minoperineal resection. and 13 patients underwent lap APR, based on preoperative

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