Page 27 - Journal of World Association of Laparoscopic Surgeons

RESEARCH ARTICLE
Comparative Analysis of Surgical and Pathological Outcomes

between Laparoscopic and Open Rectal Cancer Surgeries:

Single Institution Experience

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Subbiah Shanmugam , Jagadeesan G Mani 2

AbstrAct
Background: The purpose of our review is to analyze and compare the perioperative and clinicopathologic outcomes of laparoscopic-assisted
rectal surgeries (LARS) and open rectal surgeries (ORS) for rectal malignancies.
Patients and methods: A retrospective analysis of data available from June 2015 to October 2018 was performed. Patient’s demographic profile,
tumor characteristics, perioperative, and short-term clinicopathological outcomes were compiled and contrasted. Statistical tests used were
Student’s t test and Fischer’s exact test.
Results: During the study period, 34 and 24 patients underwent laparoscopic and open rectal cancer surgeries, respectively. Of 58 patients,
there were 30 men (51.7%) and 28 women (48.3%) with average age group of 51.7 years. The median tumor distance was 4 cm and 6 cm
from the anal verge in the laparoscopic and open groups, respectively (p = 0.03). 70.1% of patients underwent preoperative chemoradiation.

Conversion rate noted was 14.7%. Operative duration was prolonged for laparoscopic resection (194.7 vs 178.3 minutes, p = 0.168). Blood loss

(395.58 vs 506.66 mL), postoperative hospital stay (8.3 vs 11.5 days: mean difference, 3.2 days), 30-day mortality (3% vs 0% p = 0.81), and major

complications (11.8% vs 16.7%) failed to differ significantly. Negative circumferential radial margin was noticed in 98.4% of the overall group
(94.1% laparoscopic resection and 95.8% open resection; p = 0.93).

Conclusion: There were certainly no significant differences between laparoscopic and open surgeries in operative time period, complications,
and duration of hospital stay. Hence, laparoscopic surgery is oncologically safe in rectal cancer patients.
Clinical significance: Laparoscopic rectal cancer surgeries could be feasible with equivalent short-term outcomes as with open surgeries with
less morbidity, even among patients treated with preoperative chemoradiation.
Keywords: Laparoscopic resections, Pathological outcomes, Perioperative outcomes, Rectal cancers, Retrospective comparative study.
World Journal of Laparoscopic Surgery (2019): 10.5005/jp-journals-10033-1361

IntroductIon
Surgical therapy plays an integral role in the comprehensive 1,2 Department of Surgical Oncology, Government Royapettah Hospital,
management of rectal cancer. Total mesorectal excision (TME) done Kilpauk Medical College, Chennai, Tamil Nadu, India
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as a part of radical resection significantly improves the prognosis. Corresponding Author: Jagadeesan G Mani, Department of Surgical
Though laparoscopic rectal surgeries have been associated with a Oncology, Government Royapettah Hospital, Kilpauk Medical
steep learning curve, high conversion rate, and in need of consistent College, Chennai, Tamil Nadu, India, Phone: +91 9941019742, e-mail:
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practice, it has been evolving as an alternative to open procedures. jagusurgun@gmail.com
However, few technical difficulties like suboptimal traction and How to cite this article: Shanmugam S, Mani JG. Comparative Analysis
countertraction applied during surgeries, especially in mid- to of Surgical and Pathological Outcomes between Laparoscopic and
low-rectal bulky cancers, in obese patients with narrow pelvis are Open Rectal Cancer Surgeries: Single Institution Experience. World J
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causing concerns for laparoscopic surgeons. Lap Surg 2019;12(1):19–24.
There have been many studies reporting better short-term Source of support: Nil

outcomes after laparoscopic surgery such as lower morbidity, reduced Conflict of interest: None

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blood loss, reduced pain, and faster recovery. Although laparoscopy
may be considered the gold standard for the treatment of rectal
cancers, the results of recently published well-designed randomized between June 2015 and October 2018 was conducted on the basis
controlled trials, such as COLOR II, ALACART, and ACOSOG Z6051 and a of a prospectively recorded database. Records pertaining to age
meta-analysis surprisingly showed no significant differences in terms group, gender, comorbidities, tumor site and stage, neoadjuvant
of short-term morbidity between laparoscopy and open surgery, with treatment, operative time period, surgical and pathologic
5–9
very narrow 95% confidence intervals. This raised the interest and data, complications, postoperative intestinal activity, and time

made us to compare and contrast the short-term outcomes of open period of stay were investigated; almost all patients underwent
and laparoscopic rectal cancer surgeries performed in our institution. curative resection. Exclusion criterion comprised tumors with
complications like obstruction, perforation, recurrence and
PAtIents And Methods patients who underwent synchronous colectomies. A series of
Patients Assortment 24 patients who underwent standard open rectal surgeries and
Retrospective analysis of all the patients who had been subjected operated prior to the laparoscopic aided rectal procedures were
to elective laparoscopy or to laparotomy for rectal malignancy commenced and was compared to a group of 34 consecutive
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