Advertisement

Techniques in Coloproctology

, Volume 18, Issue 3, pp 247–255 | Cite as

Safety and factors contributing to the difficulty of laparoscopic surgery for rectal cancer treated with preoperative chemoradiotherapy

  • S. Ishihara
  • T. WatanabeEmail author
  • Y. Fukushima
  • T. Akahane
  • A. Horiuchi
  • R. Shimada
  • K. Nakamura
  • T. Hayama
  • H. Yamada
  • K. Nozawa
  • K. Matsuda
  • Y. Hashiguchi
Original Article

Abstract

Background

The safety of laparoscopic surgery for rectal cancer following chemoradiotherapy (CRT) has not been fully established. The aim of our retrospective study was to examine the outcomes and the factors contributing to the difficulty of laparoscopic surgery after CRT.

Methods

Eighty-seven consecutive rectal cancer patients treated with CRT were analyzed. Clinicopathological factors were compared between laparoscopic surgery (n = 57) and open surgery (n = 30) groups, and factors that correlated with operation time and blood loss were analyzed in low anterior resection (LAR) cases in the laparoscopic surgery group (n = 46).

Results

There was less blood loss in the laparoscopic surgery group than in the open surgery group (191 vs. 1,043 ml, p = 0.0001), and the operation time in the two groups was similar (329 vs. 322 min, p = 0.8). The rate of conversion from laparoscopic surgery to open surgery was 1.8 %. There was no significant difference in the morbidity rate (laparoscopic surgery 22.8 % vs. open surgery 33.3 %, p = 0.3). All circumferential resection margins were clear. Three-year cumulative rates of local recurrence were as follows: laparoscopic surgery: 1.9 % vs. open surgery: 8.4 % (p = 0.4), and distant recurrence was 28.5 % in laparoscopic surgery vs. 22.7 % in open surgery (p = 0.8) and these rates were not significantly different. In laparoscopic LAR cases, a shorter distance of the tumor from the anal verge was associated with a longer operation time. A high computed tomography Hounsfield units value of the mesorectum (CTV) was associated with increased blood loss in the first 23 cases, but not in the other 23 cases.

Conclusions

Laparoscopic surgery following CRT was safe and feasible. A shorter anal verge was associated with a longer operation time. Blood loss increased in cases with high CTV, but this can likely be mitigated by experience.

Keywords

Rectal cancer Chemoradiotherapy Laparoscopic surgery Neoadjuvant therapy 

Notes

Conflict of interest

None.

References

  1. 1.
    Clinical outcomes of surgical therapy study group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059 Google Scholar
  2. 2.
    Jayne DG, Guillou PJ, Thorpe H et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068PubMedCrossRefGoogle Scholar
  3. 3.
    Lacy AM, Delgado S, Castells A et al (2008) The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg 248:1–7PubMedCrossRefGoogle Scholar
  4. 4.
    Buunen M, Veldkamp R, Hop WC et al (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52PubMedCrossRefGoogle Scholar
  5. 5.
    Ceelen WP (2007) Use of laparoscopy for rectal cancer: a word of caution. J Clin Oncol 25:5040; author reply 5040–5041Google Scholar
  6. 6.
    Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726PubMedCrossRefGoogle Scholar
  7. 7.
    Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B, Gunnarsson U (2005) Swedish rectal cancer trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 23:5644–5650PubMedCrossRefGoogle Scholar
  8. 8.
    Peeters KC, Marijnen CA, Nagtegaal ID et al (2007) The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246:693–701PubMedCrossRefGoogle Scholar
  9. 9.
    Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740PubMedCrossRefGoogle Scholar
  10. 10.
    Ishihara S, Hayama T, Yamada H, Nozawa K, Matsuda K, Watanabe T (2011) Benefit of tegafur-uracil and leucovorin in chemoradiotherapy for rectal cancer. Hepatogastroenterology 58:756–762PubMedGoogle Scholar
  11. 11.
    Ishihara S, Watanabe T, Akahane T et al (2011) Prognostic significance of adverse events associated with preoperative radiotherapy for rectal cancer. Int J Colorectal Dis 26:911–917PubMedCrossRefGoogle Scholar
  12. 12.
    Ishihara S, Watanabe T, Nagawa H (2008) Intraoperative colonoscopy for stapled anastomosis in colorectal surgery. Surg Today 38:1063–1065PubMedCrossRefGoogle Scholar
  13. 13.
    Akiyoshi T, Kuroyanagi H, Oya M, Konishi T et al (2009) Factors affecting the difficulty of laparoscopic total mesorectal excision with double stapling technique anastomosis for low rectal cancer. Surgery 146:483–489PubMedCrossRefGoogle Scholar
  14. 14.
    Mindelzun RE, Jeffrey RB Jr, Lane MJ, Silverman PM (1996) The misty mesentery on CT: differential diagnosis. AJR Am J Roentgenol 167:61–65PubMedCrossRefGoogle Scholar
  15. 15.
    Kuroyanagi H, Oya M, Ueno M, Fujimoto Y, Yamaguchi T, Muto T (2008) Standardized technique of laparoscopic intracorporeal rectal transection and anastomosis for low anterior resection. Surg Endosc 22:557–561PubMedCrossRefGoogle Scholar
  16. 16.
    Denoya P, Wang H, Sands D, Nogueras J, Weiss E, Wexner SD (2010) Short-term outcomes of laparoscopic total mesorectal excision following neoadjuvant chemoradiotherapy. Surg Endosc 24:933–938PubMedCrossRefGoogle Scholar
  17. 17.
    Denost Q, Laurent C, Paumet T, Quintane L, Martenot M, Rullier E (2012) Laparoscopic surgery for rectal cancer: preoperative radiochemotherapy versus surgery alone. Surg Endosc 26:1878–1883PubMedCrossRefGoogle Scholar
  18. 18.
    Rosati R, Bona S, Romario UF, Elmore U, Furlan N (2007) Laparoscopic total mesorectal excision after neoadjuvant chemoradiotherapy. Surg Oncol 16(Suppl 1):S83–S89PubMedCrossRefGoogle Scholar
  19. 19.
    Akiyoshi T, Kuroyanagi H, Oya M et al (2009) Safety of laparoscopic total mesorectal excision for low rectal cancer with preoperative chemoradiation therapy. J Gastrointest Surg 13:521–525PubMedCrossRefGoogle Scholar
  20. 20.
    Kang SB, Park JW, Jeong SY et al (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11:637–645PubMedCrossRefGoogle Scholar
  21. 21.
    Cone MM, Lu KC, Herzig DO, Rea JD, Diggs BS, Oommen SC (2011) Laparoscopic proctectomy after neoadjuvant therapy: safety and long-term follow-up. Surg Endosc 25:1902–1906PubMedCrossRefGoogle Scholar
  22. 22.
    Motson RW, Khan JS, Arulampalam TH, Austin RC, Lacey N, Sizer B (2011) Laparoscopic total mesorectal excision following long course chemoradiotherapy for locally advanced rectal cancer. Surg Endosc 25:1753–1760PubMedCrossRefGoogle Scholar
  23. 23.
    Ishihara S, Iinuma H, Fukushima Y et al (2012) Radiation-induced apoptosis of peripheral blood lymphocytes is correlated with histological regression of rectal cancer in response to preoperative chemoradiotherapy. Ann Surg Oncol 19:1192–1198PubMedCrossRefGoogle Scholar
  24. 24.
    Rodel C, Liersch T, Becker H et al (2012) Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial. Lancet Oncol 13:679–687PubMedCrossRefGoogle Scholar
  25. 25.
    Sato T, Ozawa H, Hatate K et al (2011) A Phase II trial of neoadjuvant preoperative chemoradiotherapy with S-1 plus irinotecan and radiation in patients with locally advanced rectal cancer: clinical feasibility and response rate. Int J Radiat Oncol Biol Phys 79:677–683PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2013

Authors and Affiliations

  • S. Ishihara
    • 1
  • T. Watanabe
    • 1
    Email author
  • Y. Fukushima
    • 2
  • T. Akahane
    • 2
  • A. Horiuchi
    • 2
  • R. Shimada
    • 2
  • K. Nakamura
    • 2
  • T. Hayama
    • 2
  • H. Yamada
    • 2
  • K. Nozawa
    • 2
  • K. Matsuda
    • 2
  • Y. Hashiguchi
    • 2
  1. 1.Department of Surgical OncologyUniversity of TokyoBunkyo-ku, TokyoJapan
  2. 2.Department of SurgeryTeikyo UniversityTokyoJapan

Personalised recommendations