Abstract
Background
There are few reports that show that laparoscopic rectal surgery for rectal cancer had similar oncological results based on short-term benefits. The purpose of this study was to analyze our institutional short- and long-term results in laparoscopic rectal surgery and to compare these results with that reported in the literature.
Methods
The records of 121 patients who underwent sphincter-saving procedure for rectal cancer were reviewed. The variables analyzed included possible factors causing morbidity, anastomotic leak, and recurrence rate in the laparoscopic and open techniques. Multivariable analyses were used to determine relationship between variables. Survival curves were determined by using the Kaplan–Meier method.
Results
Laparoscopic sphincter-saving total mesorectal excision or partial mesorectal excision was performed in 97 patients (group 1). Twenty-four patients had open procedure (group 2). The conversion rate from laparoscopic to open technique was 10.3% (n = 10). The overall postoperative morbidity and anastomotic leak rates were 33.4% and 14.8%, respectively. There was no statistical difference in terms of postoperative morbidity (p = 0.177) and anastomotic leak (p = 0.216) between the two groups. Old age was an independent predictor for postoperative morbidity, and downstaging was an independent predictor for anastomotic leak with a sixfold increased risk. Complete downstaging to stage 0 showed a lower overall 5-year survival rate compared with non-downstaged stage I patients (79% vs. 100%). The overall local recurrence rate was 6%. There was one port site metastasis (0.8%). There were two (1.7%) postoperative deaths in group 1. The overall 5-year patient and disease-free survivals were 64% and 74%, respectively, and there was no difference between groups 1 and 2 (p = 0.801).
Conclusions
Laparoscopic sphincter-saving rectal resection for rectal cancer shows good long-term results. However, it has no advantage in terms of short-term benefits compared with the open procedure. Further studies are needed to validate the effect of downstaging on anastomotic leaks.
Similar content being viewed by others
Abbreviations
- TME:
-
Total mesorectal excision
- TNM:
-
Tumor-Node-Metastasis
- AJCC 6th ed.:
-
6th Edition of the American Joint Committee on Cancer staging
- BMI:
-
Body mass index
- PME:
-
Partial mesorectal excision
References
Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK (1998) Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 133:894–899
Heald RJ, Karanjia ND (1992) Results of radical surgery for rectal cancer. World J Surg 16:848–857
Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery: the clue to pelvic recurrence? Br J Surg 69:613–616
McAnena OJ, Heald RJ, Lockhart-Mummery HE (1990) Operative and functional results of total mesorectal excision with ultra-low anterior resection in the management of carcinoma of the lower one-third of the rectum. Surg Gynecol Obstet 170:517–521
Kapiteijn E, van De Velde CJ (2000) European trials with total mesorectal excision. Semin Surg Oncol 19:350–357
Murty M, Enker WE, Martz J (2000) Current status of total mesorectal excision and autonomic nerve preservation in rectal cancer. Semin Surg Oncol 19:321–328
Reynolds JV, Joyce WP, Dolan J, Sheahan K, Hyland JM (1983) Pathological evidence in support of total mesorectal excision in the management of rectal cancer. Br J Surg 83:1112–1115
Wong RKS, Tandan V, De Silva S, Figueredo A (2007) Cochrane preoperative radiotherapy and curative surgery for the management of localized rectal carcinoma (review). Database Syst Rev 18:CD002102
Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1:144–150
Zhou ZG, Hu M, Li Y, Lei WZ, Yu YY, Cheng Z, Li L, Shu Y, Wang TC (2004) Laparoscopic vs open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc 18:1211–1215
Leung KL, Kwok SPY, Lam SCW (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 363:1187–1192
Leung KL, Lai PB, Ho RL, Meng WC, Yiu RY, Lee JF, Lau WY (2000) Systemic cytokine response after laparoscopic-assisted resection of rectosigmoid carcinoma: a prospective randomized trial. Ann Surg 231:506–511
Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, BrownHeath JM, UK MRC CLASICC Trial Group (2007) Randomised trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC trail group. J Clin Oncol 25:3061–3068
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Breukink S, Pierie J, Wiggers T (2006) Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev 18:CD005200
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, MRC CLASICC trial group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726
Leroy J, Jamali F, Forbes L, Smith M, Rubino F, Mutter D, Marescaux J (2003) Laparoscopic total mesorectal excision (TME) for rectal cancer surgery. Surg Endosc 18:281–289
Laurent C, Leblanc F, Gineste C, Saric J, Rullier E (2007) Laparoscopic approach in surgical treatment of rectal cancer. Br J Surg 94:1555–1561
Thorpe H, Jayne DG, Guillou PJ, Quirke P, Copeland J, Brown JM, Medical Research Council Conventional versus Laparoscopic-Assisted Surgery In Colorectal Cancer Trial Group (2008) Patient factors influencing conversion from laparoscopically assisted to open surgery for colorectal cancer. Br J Surg 95(2):199–205
Curet MJ (2007) Port site metastases. Am J Surg 187:705–712
Disclosures
Drs. Hwai-Ding Lam, Mauro Stefano, Tri Tran-Ba, Nicolas Tinton, Emmanuel Cambier, and Benoit Navez have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lam, HD., Stefano, M., Tran-Ba, T. et al. Laparoscopic versus open techniques in rectal cancer surgery: a retrospective analysis of 121 sphincter-saving procedures in a single institution. Surg Endosc 25, 454–462 (2011). https://doi.org/10.1007/s00464-010-1191-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-010-1191-y