Skip to main content
SpringerLink
Log in

Laparoscopic vs. Open Total Mesorectal Excision in Unselected Patients with Rectal Cancer: Impact on Early Outcome

  • Published:
Diseases of the Colon & Rectum

Purpose

This study was designed to compare laparoscopic vs. open total mesorectal excision for cancer of the rectum on perioperative outcome and quality of life.

Methods

A total of 187 consecutive unselected patients with rectal cancer who underwent total mesorectal excision during a seven-year period were prospectively evaluated. Patients were monitored 30 days for postoperative complications. Quality of life was evaluated before and at one year after surgery.

Results

A total of 108 patients underwent laparoscopic total mesorectal excision, whereas 79 underwent open. Conversion rate was 12 percent. In the laparoscopic group, operating time was 33 minutes longer (P = 0.03) and intraoperative blood loss was lower (P = 0.001). Tumor stage and the number of lymph nodes that were intraoperatively collected were similar in the two groups. The overall morbidity rate was 29.6 percent in the laparoscopic and 27.8 percent in the open (P = 0.78) group. No patient died during the postoperative period. Anastomotic leak rate was similar in the two groups (14.8 percent in laparoscopic vs. 12.6 percent in open; P = 0.88). Patients in the laparoscopic group recovered earlier bowel function (P = 0.01) and experienced a shorter length of stay (P = 0.003). At one-year follow-up, overall quality of life was similar in the two groups. In the laparoscopic group, social functioning item was significantly better (P = 0.05) and trend to a better physical status was observed (P = 0.07).

Conclusions

Laparoscopic total mesorectal excision is safe and feasible, does not jeopardize the complication rate, and has the benefits of much less blood during the operation and shorter hospitalization.

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

Figure 1

Similar content being viewed by others

References

  1. NS Abraham JM Young MJ Solomon (2004) ArticleTitleMeta-analysis of short term outcomes after laparoscopic resection for colorectal cancer Br J Surg 91 1111–1124 Occurrence Handle15449261 Occurrence Handle10.1002/bjs.4640 Occurrence Handle1:STN:280:DC%2BD2cvnvFSmuw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  2. A Vignali M Braga W Zuliani M Frasson G Radaelli V Carlo ParticleDi (2004) ArticleTitleLaparoscopic colorectal surgery modifies risk factors for postoperative morbidity Dis Colon Rectum 47 1686–1693 Occurrence Handle15540300 Occurrence Handle10.1007/s10350-004-0653-5

    Article  PubMed  Google Scholar 

  3. JW Milsom B Bohm KA Hammerhoffer VW Fazio E Steiger P Elson (1998) ArticleTitleA prospective randomized trial comparing laparoscopic vs conventional techniques in colorectal cancer surgery. A preliminary report J Am Coll Surg 187 46–57 Occurrence Handle9660024 Occurrence Handle10.1016/S1072-7515(98)00132-X Occurrence Handle1:STN:280:DyaK1czitFClsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  4. M Braga A Vignali L Gianotti et al. (2002) ArticleTitleLaparoscopic versus open colorectal surgery. A randomized trial on short-term outcome Ann Surg 236 759–767 Occurrence Handle12454514 Occurrence Handle10.1097/00000658-200212000-00008

    Article  PubMed  Google Scholar 

  5. H Nelson DJ Sargent HS Wieand et al. (2004) ArticleTitleA comparison of laparoscopically assisted and open colectomy for colon cancer N Engl J Med 350 2050–2059 Occurrence Handle10.1056/NEJMoa032651 Occurrence Handle1:CAS:528:DC%2BD2cXktVemsbw%3D

    Article  CAS  Google Scholar 

  6. EJ Hazebroek (2002) ArticleTitleCOLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer Surg Endosc 16 949–953 Occurrence Handle12163961 Occurrence Handle10.1007/s00464-001-8165-z Occurrence Handle1:STN:280:DC%2BD38vgvFGmsQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  7. KL Leung SP Kwok SC Lam et al. (2004) ArticleTitleLaparoscopic resection of rectosigmoid carcinoma: prospective randomised trial Lancet 363 1187–1192 Occurrence Handle15081650 Occurrence Handle10.1016/S0140-6736(04)15947-3

    Article  PubMed  Google Scholar 

  8. P Guillou P Quirke H Thorpe et al. (2005) ArticleTitleShort-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer: multicentre, randomized controlled trial Lancet 365 1718–1726 Occurrence Handle15894098 Occurrence Handle10.1016/S0140-6736(05)66545-2

    Article  PubMed  Google Scholar 

  9. AM Lacy JC Garcia-Valdecasas S Delgado et al. (2002) ArticleTitleLaparoscopic-assisted colectomy vs open colectomy for treatment of non-metastatic colon cancer: a randomized trial Lancet 359 2224–2229 Occurrence Handle12103285 Occurrence Handle10.1016/S0140-6736(02)09290-5

    Article  PubMed  Google Scholar 

  10. WX Wu YM Sun YB Hua LZ Shen (2004) ArticleTitleLaparoscopic versus conventional open resection of rectal carcinoma: a clinical comparative study World J Gastroenterol 10 1167–1170 Occurrence Handle15069719

    PubMed  Google Scholar 

  11. JE Hartley BJ Mehigan EQ Akhtar et al. (2001) ArticleTitleTotal mesorectal excision: assessment of the laparoscopic approach Dis Colon Rectum 44 315–321 Occurrence Handle11289275 Occurrence Handle10.1007/BF02234726 Occurrence Handle1:STN:280:DC%2BD3M7pvFyktw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  12. M Morino U Parini G Girando S Micky R Brachet Contul C Garrone (2003) ArticleTitleLaparoscopic total mesorectal excision: a consecutive series of 100 patients Ann Surg 237 335–342 Occurrence Handle12616116 Occurrence Handle10.1097/00000658-200303000-00006

    Article  PubMed  Google Scholar 

  13. E Rullier AS Cunha P Coudere A Rullier R Gontier J Saric (2003) ArticleTitleLaparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer Br J Surg 90 445–451 Occurrence Handle12673746 Occurrence Handle10.1002/bjs.4052 Occurrence Handle1:STN:280:DC%2BD3s7ls1yiug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  14. J Leroy F Jamali L Forbes et al. (2004) ArticleTitleLaparoscopic total mesorectal excision (TME) for rectal cancer surgery. Long-term outcomes Surg Endosc 18 281–289 Occurrence Handle14691716 Occurrence Handle10.1007/s00464-002-8877-8 Occurrence Handle1:STN:280:DC%2BD2c7kvFeluw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  15. SH Kim IJ Park YG Joh KY Hahn (2006) ArticleTitleLaparoscopic resection for rectal cancer: a prospective analysis of thirty-month follow-up outcomes in 312 patients Surg Endosc 20 1197–1202 Occurrence Handle16865622 Occurrence Handle10.1007/s00464-005-0599-2

    Article  PubMed  Google Scholar 

  16. S Kitano M Kitajima F Konishi et al. (2006) ArticleTitleA multicenter study on laparoscopic surgery for colorectal cancer in Japan Surg Endosc 20 1348–1352 Occurrence Handle16865630 Occurrence Handle10.1007/s00464-004-8247-9 Occurrence Handle1:STN:280:DC%2BD28rmtlCqtw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  17. A Vignali S Palo ParticleDi A Tamburini G Radaelli E Orsenigo C Staudacher (2005) ArticleTitleLaparoscopic vs. open colectomies in octogenarians: a case-matched control study Dis Colon Rectum 48 2070–2075 Occurrence Handle16086219 Occurrence Handle10.1007/s10350-005-0147-0

    Article  PubMed  Google Scholar 

  18. RJ Heald RD Hyall (1986) ArticleTitleRecurrence and survival after total mesorectal excision for rectal cancer Lancet 28 1479–1482 Occurrence Handle10.1016/S0140-6736(86)91510-2

    Article  Google Scholar 

  19. A Vignali VW Fazio IC Lavery et al. (1997) ArticleTitleFactors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients J Am Coll Surg 185 113–121

    Google Scholar 

  20. JE Ware SuffixJr CD Shelbourne (1992) ArticleTitleThe MOS 36-item short-form health survey (SF-36). Conceptual framework and item selection Med Care 30 473–483 Occurrence Handle1593914 Occurrence Handle10.1097/00005650-199206000-00002

    Article  PubMed  Google Scholar 

  21. P Rauch J Miny T Conroy L Neyton F Guillemin (2004) ArticleTitleQuality of life among disease-free survivors of rectal cancer J Clin Oncol 22 354–360 Occurrence Handle14722043 Occurrence Handle10.1200/JCO.2004.03.137

    Article  PubMed  Google Scholar 

  22. M Braga M Frasson A Vignali W Zuliani V Civelli V Carlo ParticleDi (2005) ArticleTitleLaparoscopic vs. open colectomy in cancer patients: long-term complications, quality of life and survival Dis Colon Rectum 48 2217–2223 Occurrence Handle16228828 Occurrence Handle10.1007/s10350-005-0185-7

    Article  PubMed  Google Scholar 

  23. S Breukink J Pierie T Wiggers (2006) ArticleTitleLaparoscopic versus total mesorectal excision for rectal cancer Cochrane Database Syst Rev 4 1–42

    Google Scholar 

  24. AI Gonzales LH Diaz MA Malagon et al. (2006) ArticleTitleA comparative clinical study of short-term results of laparoscopic surgery for rectal cancer during the learning curve Int J Colorectal Dis 21 590–595 Occurrence Handle10.1007/s00384-005-0057-6

    Article  Google Scholar 

  25. M Morino ME Allaix F Girando F Corno C Garrone (2005) ArticleTitleLaparoscopic versus open surgery for extraperitoneal rectal cancer Surg Endosc 19 1460–1467 Occurrence Handle16206013 Occurrence Handle10.1007/s00464-004-2001-1 Occurrence Handle1:STN:280:DC%2BD2MnkslCjsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  26. WL Law MY Lee HK Choi CL Seto JW Ho (2006) ArticleTitleLaparoscopic and open anterior resection for upper and mid rectal cancer: an evaluation of outcomes Dis Colon Rectum 49 1108–1115 Occurrence Handle16763756 Occurrence Handle10.1007/s10350-006-0551-0

    Article  PubMed  Google Scholar 

  27. J Marescaux F Rubino J Leroy (2005) ArticleTitleLaparoscopic total mesorectal excision for rectal cancer surgery Dig Dis 23 135–141 Occurrence Handle16352893 Occurrence Handle10.1159/000088595

    Article  PubMed  Google Scholar 

  28. S Delgado D Momblan L Salvador et al. (2004) ArticleTitleLaparoscopic-assisted approach in rectal cancer patients. Lesson learned from > 200 patients Surg Endosc 18 1457–1462 Occurrence Handle15791369 Occurrence Handle10.1007/s00464-003-8831-4 Occurrence Handle1:STN:280:DC%2BD2M7lvVOhsg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  29. WW Tsang CC Chung SY Kwok MK Li (2006) ArticleTitleLaparoscopic sphincter-preserving total mesorectal excision with colonic j-pouch reconstruction. Five year results Ann Surg 243 353–358 Occurrence Handle16495700 Occurrence Handle10.1097/01.sla.0000202180.16723.03 Occurrence Handle1:STN:280:DC%2BD287gvVWmsg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  30. O Aziz V Costantinides P Tekkis et al. (2006) ArticleTitleLaparoscopic versus open surgery for rectal cancer: a meta-analysis Ann Surg Oncol 13 413–424 Occurrence Handle16450220 Occurrence Handle10.1245/ASO.2006.05.045

    Article  PubMed  Google Scholar 

  31. DP Edwards A Leppington-Clarke R Sexton RJ Heald BJ Moran (2001) ArticleTitleStoma-related complications are more frequent after transverse colostomy than loop ileostomy: a prospective randomised trial Br J Surg 88 360–363 Occurrence Handle11260099 Occurrence Handle10.1046/j.1365-2168.2001.01727.x Occurrence Handle1:STN:280:DC%2BD3M7mtVaqtg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  32. WL Law KW Chu HK Choi (2002) ArticleTitleRandomized clinical trial comparing loop ileostomy and loop transverse colostomy for faecal diversion following total mesorectal excision Br J Surg 89 704–708 Occurrence Handle12027979 Occurrence Handle10.1046/j.1365-2168.2002.02082.x Occurrence Handle1:STN:280:DC%2BD383ovVSqsQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  33. J Pachler P Wille-Jorgensen (2005) ArticleTitleQuality of life in patients after rectal resection for cancer with or without permanent colostomy (review) Cochrane Database Syst Rev 2 1–20

    Google Scholar 

  34. J Camilleri-Brennan RJ Steele (2001) ArticleTitleProspective analysis of quality of life and survival following mesorectal excision for rectal cancer Br J Surg 88 1617–1622 Occurrence Handle11736975 Occurrence Handle10.1046/j.0007-1323.2001.01933.x Occurrence Handle1:STN:280:DC%2BD3MnptVGmtg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  35. V Arndt H Merx C Stegmaier H Ziegler H Brenner (2004) ArticleTitleQuality of life in patients with colorectal cancer 1 year after diagnosis compared with general population: a population-based study J Clin Oncol 22 4829–4836 Occurrence Handle15570086 Occurrence Handle10.1200/JCO.2004.02.018

    Article  PubMed  Google Scholar 

  36. S Sultan DA Fisher CI Voils AY Kinney RS Sancler D Provenzale (2004) ArticleTitleImpact of quality of functional support on health-related quality of life in patients with colorectal cancer Cancer 101 2737–2743 Occurrence Handle15536617 Occurrence Handle10.1002/cncr.20699

    Article  PubMed  Google Scholar 

  37. CE Schmidt B Bestmann T Kuchler WE Longo V Rohde B Kremer (2005) ArticleTitleGender differences in quality of life of patients with rectal cancer. A five-year prospective study World J Surg 29 1630–1641 Occurrence Handle16311851 Occurrence Handle10.1007/s00268-005-0067-0

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, San Raffaele University, Via Olgettina 60, Milan, 20132, Italy

    Carlo Staudacher M.D., Andrea Vignali M.D., Di Palo Saverio M.D., Orsenigo Elena M.D. & Tamburini Andrea M.D.

Authors
  1. Carlo Staudacher M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrea Vignali M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Di Palo Saverio M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Orsenigo Elena M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tamburini Andrea M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrea Vignali M.D..

About this article

Cite this article

Staudacher, C., Vignali, A., Saverio, D.P. et al. Laparoscopic vs. Open Total Mesorectal Excision in Unselected Patients with Rectal Cancer: Impact on Early Outcome. Dis Colon Rectum 50, 1324–1331 (2007). https://doi.org/10.1007/s10350-007-0289-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-007-0289-3

Key words

Search

Navigation