Skip to main content

Advertisement

SpringerLink
Log in

Short-term follow-up after laparoscopic versus conventional total mesorectal excision for low rectal cancer in a large teaching hospital

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Laparoscopic resection for low rectal cancer remains controversial, and large randomized studies on oncologic outcome are lacking. The objective of this study was to analyze the short-term results of laparoscopic resection versus conventional total mesorectal excision (TME) for low rectal cancer (≤10 cm from the anal verge).

Methods

The institutional colorectal surgery database was reviewed, and 166 consecutive patients operated for low rectal cancer between 2006 and 2011 were included in this analysis which focuses on the first 18 months of follow-up.

Results

Eighty patients underwent conventional TME, whereas 86 patients underwent laparoscopic TME. Patient characteristics were comparable between groups. Conversion rate was 17 %. Laparoscopic rectal resection resulted in significantly less blood loss (200 versus 475 ml, p = <0.001) and a 3-day shorter hospital stay (median, 7 versus 10 days; p = 0.06). Oncologic results from resected specimens were comparable, although significantly more lymph nodes were harvested in laparoscopic resections (median, 13 versus 11; p = 0.005). Disease-free survival after curative resection was better in the laparoscopic group (p = 0.04), but this was no longer significant after correction for potential confounders.

Conclusions

This analysis of short-term results of laparoscopic versus conventional TME for low rectal cancer demonstrates that laparoscopic surgery is feasible and safe, resulting in similar oncologic outcomes with less blood loss, a trend towards less postoperative complications and shorter duration of hospital stay. Further randomized studies are needed to attribute to the body of evidence of equivalence or even superiority of laparoscopic resections compared to conventional resections for distal rectal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726. doi:10.1016/S0140-6736(05)66545-2

    Article  PubMed  Google Scholar 

  2. Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10(1):44–52. doi:10.1016/S1470-2045(08)70310-3

    Article  PubMed  Google Scholar 

  3. Kuhry E, Schwenk W, Gaupset R, Romild U, Bonjer J (2008) Long-term outcome of laparoscopic surgery for colorectal cancer: a cochrane systematic review of randomised controlled trials. Cancer Treat Rev 34(6):498–504. doi:10.1016/j.ctrv.2008.03.011

    Article  PubMed  Google Scholar 

  4. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6(7):477–484. doi:10.1016/S1470-2045(05)70221-7

    Article  PubMed  Google Scholar 

  5. McKay GD, Morgan MJ, Wong SK, Gatenby AH, Fulham SB, Ahmed KW, Toh JW, Hanna M, Hitos K (2011) Improved short-term outcomes of laparoscopic versus open resection for colon and rectal cancer in an area health service: a multicenter study. Dis Colon Rectum 55(1):42–50. doi:10.1097/DCR.0b013e318239341f

    Article  Google Scholar 

  6. Barlehner E, Benhidjeb T, Anders S, Schicke B (2005) Laparoscopic resection for rectal cancer: outcomes in 194 patients and review of the literature. Surg Endosc 19(6):757–766. doi:10.1007/s00464-004-9134-0

    Article  CAS  PubMed  Google Scholar 

  7. Ng KH, Ng DC, Cheung HY, Wong JC, Yau KK, Chung CC, Li MK (2009) Laparoscopic resection for rectal cancers: lessons learned from 579 cases. Ann Surg 249(1):82–86. doi:10.1097/SLA.0b013e31818e418a

    Article  PubMed  Google Scholar 

  8. Seshadri RA, Srinivasan A, Tapkire R, Swaminathan R (2011) Laparoscopic versus open surgery for rectal cancer after neoadjuvant chemoradiation: a matched case–control study of short-term outcomes. Surg Endosc 26(1):154–161. doi:10.1007/s00464-011-1844-5

    Article  PubMed  Google Scholar 

  9. Leroy J, Jamali F, Forbes L, Smith M, Rubino F, Mutter D, Marescaux J (2004) Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 18(2):281–289. doi:10.1007/s00464-002-8877-8

    Article  CAS  PubMed  Google Scholar 

  10. Lujan J, Valero G, Hernandez Q, Sanchez A, Frutos MD, Parrilla P (2009) Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg 96(9):982–989. doi:10.1002/bjs.6662

    Article  CAS  PubMed  Google Scholar 

  11. Buunen M, Bonjer HJ, Hop WC, Haglind E, Kurlberg G, Rosenberg J, Lacy AM, Cuesta MA, D’Hoore A, Furst A, Lange JF, Jess P, Bulut O, Poornoroozy P, Jensen KJ, Christensen MM, Lundhus E, Ovesen H, Birch D, Iesalnieks I, Jager C, Kreis M, van riet Y, van der Harst E, Gerhards MF, Bemelman WA, Hansson BM, Neijenhuis PA, Prins HA, Balague C, Targarona E, Lujan Mompean JA, Franco Osorio JD, Garcia Molina FJ, Skullman S, Lackberg Z, Kressner U, Matthiessen P, Kim SH, Poza AA (2009) COLOR II. A randomized clinical trial comparing laparoscopic and open surgery for rectal cancer. Dan Med Bull 56(2):89–91

    CAS  PubMed  Google Scholar 

  12. van der Pas MH, Haglind E, Cuesta MA, Furst A, Lacy AM, Hop WC, Bonjer HJ (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14(3):210–218. doi:10.1016/S1470-2045(13)70016-0

    Article  PubMed  Google Scholar 

  13. Shearer R, Gale M, Aly OE, Aly EH (2013) Have early post-operative complications from laparoscopic rectal cancer surgery improved over the past 20 years? Colorectal Dis. doi:10.1111/codi.12302

    PubMed  Google Scholar 

  14. Guren MG, Eriksen MT, Wiig JN, Carlsen E, Nesbakken A, Sigurdsson HK, Wibe A, Tveit KM (2005) Quality of life and functional outcome following anterior or abdominoperineal resection for rectal cancer. Eur J Surg Oncol 31(7):735–742

    Article  CAS  PubMed  Google Scholar 

  15. Marr R, Birbeck K, Garvican J, Macklin CP, Tiffin NJ, Parsons WJ, Dixon MF, Mapstone NP, Sebag-Montefiore D, Scott N, Johnston D, Sagar P, Finan P, Quirke P (2005) The modern abdominoperineal excision: the next challenge after total mesorectal excision. Ann Surg 242(1):74–82

    Article  PubMed  Google Scholar 

  16. Nagtegaal ID, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26(2):303–312. doi:10.1200/JCO.2007.12.7027

    Article  PubMed  Google Scholar 

  17. West NP, Finan PJ, Anderin C, Lindholm J, Holm T, Quirke P (2008) Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer. J Clin Oncol 26(21):3517–3522. doi:10.1200/JCO.2007.14.5961

    Article  PubMed  Google Scholar 

  18. Wibe A, Syse A, Andersen E, Tretli S, Myrvold HE, Soreide O (2004) Oncological outcomes after total mesorectal excision for cure for cancer of the lower rectum: anterior vs. abdominoperineal resection. Dis Colon Rectum 47(1):48–58. doi:10.1007/s10350-003-0012-y

    Article  PubMed  Google Scholar 

  19. http://www.oncoline.nl/rectumcarcinoom. Accessed 1 July 2013

  20. Heald RJ (1998) Total mesorectal excision. The new European gold standard. G Chir 19(6–7):253–255

    CAS  PubMed  Google Scholar 

  21. Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van Krieken JH, Leer JW, van de Velde CJ (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345(9):638–646. doi:10.1056/NEJMoa010580

    Article  CAS  PubMed  Google Scholar 

  22. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

    Article  CAS  PubMed  Google Scholar 

  23. Bakx R, Emous M, Legemate DA, Machado M, Zoetmulder FA, van Tets WF, Bemelman WA, Slors JF, van Lanschot JJ (2006) Categorization of major and minor complications in the treatment of patients with resectable rectal cancer using short-term pre-operative radiotherapy and total mesorectal excision: a Delphi round. Colorectal Dis 8(4):302–308. doi:10.1111/j.1463-1318.2005.00937.x

    Article  CAS  PubMed  Google Scholar 

  24. Anderson C, Uman G, Pigazzi A (2008) Oncologic outcomes of laparoscopic surgery for rectal cancer: a systematic review and meta-analysis of the literature. Eur J Surg Oncol 34(10):1135–1142. doi:10.1016/j.ejso.2007.11.015

    Article  CAS  PubMed  Google Scholar 

  25. Breukink SO, Grond AJ, Pierie JP, Hoff C, Wiggers T, Meijerink WJ (2005) Laparoscopic vs open total mesorectal excision for rectal cancer: an evaluation of the mesorectum’s macroscopic quality. Surg Endosc 19(3):307–310. doi:10.1007/s00464-004-9066-8

    Article  CAS  PubMed  Google Scholar 

  26. Kang SB, Park JW, Jeong SY, Nam BH, Choi HS, Kim DW, Lim SB, Lee TG, Kim DY, Kim JS, Chang HJ, Lee HS, Kim SY, Jung KH, Hong YS, Kim JH, Sohn DK, Kim DH, Oh JH (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(7):637–645. doi:10.1016/S1470-2045(10)70131-5

    Article  PubMed  Google Scholar 

  27. Lelong B, Bege T, Esterni B, Guiramand J, Turrini O, Moutardier V, Magnin V, Monges G, Pernoud N, Blache JL, Giovannini M, Delpero JR (2007) Short-term outcome after laparoscopic or open restorative mesorectal excision for rectal cancer: a comparative cohort study. Dis Colon Rectum 50(2):176–183. doi:10.1007/s10350-006-0751-7

    Article  PubMed  Google Scholar 

  28. Veenhof AA, Vlug MS, van der Pas MH, Sietses C, van der Peet DL, de Lange-de Klerk ES, Bonjer HJ, Bemelman WA, Cuesta MA (2012) Surgical stress response and postoperative immune function after laparoscopy or open surgery with fast track or standard perioperative care: a randomized trial. Ann Surg 255(2):216–221. doi:10.1097/SLA.0b013e31824336e2

    Article  CAS  PubMed  Google Scholar 

  29. Wang G, Jiang Z, Zhao K, Li G, Liu F, Pan H, Li J (2012) Immunologic response after laparoscopic colon cancer operation within an enhanced recovery program. J Gastrointest Surg 16(7):1379–1388. doi:10.1007/s11605-012-1880-z

    Article  PubMed  Google Scholar 

  30. Novitsky YW, Litwin DE, Callery MP (2004) The net immunologic advantage of laparoscopic surgery. Surg Endosc 18(10):1411–1419. doi:10.1007/s00464-003-8275-x

    Article  CAS  PubMed  Google Scholar 

  31. Sietses C, Beelen RH, Meijer S, Cuesta MA (1999) Immunological consequences of laparoscopic surgery, speculations on the cause and clinical implications. Langenbecks Arch Surg 384(3):250–258

    Article  CAS  PubMed  Google Scholar 

  32. Wichmann MW, Huttl TP, Winter H, Spelsberg F, Angele MK, Heiss MM, Jauch KW (2005) Immunological effects of laparoscopic vs open colorectal surgery: a prospective clinical study. Arch Surg 140(7):692–697. doi:10.1001/archsurg.140.7.692

    Article  PubMed  Google Scholar 

  33. Wind J, Tuynman JB, Tibbe AG, Swennenhuis JF, Richel DJ, van Berge Henegouwen MI, Bemelman WA (2009) Circulating tumour cells during laparoscopic and open surgery for primary colonic cancer in portal and peripheral blood. Eur J Surg Oncol 35(9):942–950. doi:10.1016/j.ejso.2008.12.003

    Article  CAS  PubMed  Google Scholar 

  34. Aziz O, Constantinides V, Tekkis PP, Athanasiou T, Purkayastha S, Paraskeva P, Darzi AW, Heriot AG (2006) Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol 13(3):413–424. doi:10.1245/ASO.2006.05.045

    Article  PubMed  Google Scholar 

  35. Akiyoshi T, Kuroyanagi H, Oya M, Konishi T, Fukuda M, Fujimoto Y, Ueno M, Miyata S, Yamaguchi T (2009) Factors affecting the difficulty of laparoscopic total mesorectal excision with double stapling technique anastomosis for low rectal cancer. Surgery 146(3):483–489. doi:10.1016/j.surg.2009.03.030

    Article  PubMed  Google Scholar 

  36. Laurent C, Leblanc F, Wutrich P, Scheffler M, Rullier E (2009) Laparoscopic versus open surgery for rectal cancer: long-term oncologic results. Ann Surg 250(1):54–61. doi:10.1097/SLA.0b013e3181ad6511

    Article  PubMed  Google Scholar 

  37. Milsom JW, Trencheva KI, Pandey S, Lee SW, Sonoda T (2009) Long-term outcomes of patients undergoing curative laparoscopic surgery for mid and low rectal cancer. Dis Colon Rectum 52(7):1215–1222. doi:10.1007/DCR0b013e3181a73e81

    Article  PubMed  Google Scholar 

  38. Brannigan AE, De Buck S, Suetens P, Penninckx F, D’Hoore A (2006) Intracorporeal rectal stapling following laparoscopic total mesorectal excision: overcoming a challenge. Surg Endosc 20(6):952–955. doi:10.1007/s00464-005-0536-4

    Article  CAS  PubMed  Google Scholar 

  39. Brescia A, Mari FS, Favi F, Milillo A, Nigri G, Dall’oglio A, Pancaldi A, Masoni L (2013) Laparoscopic lower anterior rectal resection using a curved stapler: original technique and preliminary experience. Am Surg 79(3):253–256

    PubMed  Google Scholar 

  40. Mari FS, Gasparrini M, Nigri G, Berardi G, Laracca GG, Flora B, Pancaldi A, Brescia A (2013) Can a curved stapler made for open surgery be useful in laparoscopic lower rectal resections? Technique and experience of a single centre. Surgeon 11(Suppl 1):S23–S26. doi:10.1016/j.surge.2012.10.001

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands

    A. H. W. Schiphorst, A. Doeksen, D. D. E. Zimmerman & A. Pronk

  2. Department of Geriatric Medicine, Diakonessenhuis, Utrecht, The Netherlands

    M. E. Hamaker

Authors
  1. A. H. W. Schiphorst
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Doeksen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. E. Hamaker
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. D. E. Zimmerman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Pronk
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. H. W. Schiphorst.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schiphorst, A.H.W., Doeksen, A., Hamaker, M.E. et al. Short-term follow-up after laparoscopic versus conventional total mesorectal excision for low rectal cancer in a large teaching hospital. Int J Colorectal Dis 29, 117–125 (2014). https://doi.org/10.1007/s00384-013-1768-8

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-013-1768-8

Keywords

Search

Navigation