Page 23 - Journal of World Association of Laparoscopic Surgeons
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Comparative Analysis of Surgical and Pathological Outcomes
            Table 1: Patient’s baseline characteristics
                                                                Laparoscopic-assisted rectal   Open rectal surgeries

            S. no.   Parameters              Group              surgeries (LARS) N  (%)  (ORS) N  (%)     p value
              1      No. of patients                            34 (58.6%)             24 (41.4%)         –
              2      Age (years)             Mean ± SD          52.41 ± 13.01          50.62 ± 13.01      0.6086
              3      Sex                     Male               15 (44.1%)             15 (62.5%)         0.1676
                                             Female             19 (55.9%)             9 (37.5%)
              4      Serum albumin (g/dL)    Mean ± SD          4.27 ± 0.55            3.76 ± 0.42        0.1171
              5      Serum CEA* (ng/mL)      Median             9.85                   22.25              0.9773
              6      Distance from anal verge (cm)  Median      4                      6                  0.3369
              7      Location of tumor       Upper third        8 (23.5%)              5 (20.8%)          0.6215
                                             (12–17 cm from AV)  4 (11.8%)             9 (37.5%)
                                             Middle third       22 (64.7%)             10 (41.7%)
                                             (7–12 cm from AV**)
                                             Lower third (<7 cm from
                                             AV)
              8      Neoadjuvant chemo RT    Given              23 (67.6%)             18 (75%)           0.5445
                                             Not given          11 (32.4%)             6 (25%)
              9      Clinical T stage        cT2–T3             29 (85.3%)             20 (83.3%)         0.8390
                                             cT4                5 (14.7%)              416.7%)
            10       Clinical N stage        Negative           12 (35.3%)             7 (29.2%)          0.6243
                                             Positive           22 (64.7%)             17 (70.8%)
            11       Distant metastasis      Present            0 (0%)                 0 (0%)             0.8011
                                             Absent             34 (100%)              24 (100%)
            12       Clinical stage group    Stage I–II         13 (38.2%)             7 (20.6%)          0.4742
                                             Stage III          21 (61.8%)             17 (70.8%)
            *CEA, carcinoembryonic antigen
            **AV, anal verge

            Table 2: Surgical data
                                                                   Laparoscopic-assisted   Open rectal
            Parameters                 Group                       rectal surgeries (LARS)  surgeries (ORS)  p value

            Type of surgery            Anterior resection          7 (20.6%)             4 (16.7%)
                                       Low anterior resection      6 (17.6%)             11 (45.8%)        0.0749
                                       Abdominoperineal resection  18 (52.9%)            5 (20.8%)
                                       Posterior pelvic exenteration  2 (5.9%)           2 (8.3%)
                                       Total pelvic exenteration   1 (2.9%)              2 (8.3%)
            Operative time             Mean ± SD (in minutes)      194.7 ± 40.43         178.3 ± 48.51     0.1676
            Intraoperative blood loss  Mean ± SD (in mL)           295.58 ± 83.55        406.66 ± 137.97   0.0491
            Intraoperative complications  Present                  0 (0%)                2 (8.3%)          0.3611
                                       Absent                      34 (100%)             22 (91.7%)
            Incidence                  Bladder injury              Nil                   1
                                       Ureteric injury             Nil                   1


            Although the number of lymph nodes harvested tended to be more   procedures took longer time (240 vs 188 minutes), the patients
            in the ORS group, the difference did not reach statistical significance.  in that group had significantly less blood loss (200 vs 400 mL),
                                                               earlier return of bowel (2 vs 3 days), and shorter hospital length of
                                                               stay (LOS) (8 vs 9 days). The 28-day morbidity and mortality were
            dIscussIon                                         similar in both groups. Similarly, our study cohorts also showed
            Three randomized controlled trials have demonstrated that the   that patients treated with laparoscopic-assisted rectal resection
            oncological outcomes of laparoscopic surgery for the rectal cancer   though statistically not significant took longer operating time

            are comparable to those of open surgery. 7,10,11   (195 vs 175 minutes) with minimal blood loss (295 vs 405 mL),
               In the first study, the COLOR II trial, Van der Pas et al. pro-  0.95 day earlier return of bowel movements, and shorter hospital
            spectively randomized 1,103 patients with rectal cancer to either   day by 3 days. The morbidity and mortality patterns of our study
                                         12
            laparoscopic or open proctectomy.   Although laparoscopic   cohorts are in concordance with COLOR II trial population.

                                                       World Journal of Laparoscopic Surgery, Volume 12 Issue 1 (January–April 2019)  21
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