Laparoscopic and converted approaches to rectal cancer resection have superior long-term outcomes: a comparative study by operative approach

Abstract

LAP and converted procedures have comparable or superior clinical and oncologic outcomes. More procedures should be approached through a LAP approach. If the procedure cannot be completed laparoscopically, outcomes are not compromised for converted patients.

A population-based comparison of open versus minimally invasive abdominoperineal resection

“…19 Perioperative complications, evaluated by ICD-9-CM codes from the NIS database, are equivalent, if not lower than previous reports, and this might be a result of increased surgeon experience. 2,4,5,20 The rate of a laparoscopic converted to an open APR in this study was low. This may be secondary to the implementation of robotic assistance or the use of hand-assisted laparoscopy.…”

“…3,4 These trials demonstrated significant benefits with the laparoscopic approach including a reduction in postoperative ileus, decreased length of stay (LOS), lower risk of a nonroutine discharge, and a reduction in cost. 2,5 Comparable results have also been demonstrated in laparoscopic cases that were converted to open and those using a small ''minilaparotomy.'' 9 These studies also advocate attempting laparoscopy for most colorectal cancers regardless of disease stage.…”

“…9 These studies also advocate attempting laparoscopy for most colorectal cancers regardless of disease stage. 5 The publication of the Conventional Versus Laparoscopic-Assisted Surgery in Colorectal Cancer (CLASICC) trial in 2007 was important as it was the first trial to prospectively evaluate the oncological outcomes of a laparoscopic anterior resection and APR. 3 This study reported that a laparoscopic approach is as effective as an open approach in regards to cancer treatment.…”

“…However, previous studies advocating for this technique have included small sample sizes, are from single institutions, and required surgeons to have a defined number of cases or demonstrate their technique before enrollment. 4,5,[10][11][12][13][14][15] These study limitations have questioned the applicability of these recommendations at a national level where there is a greater variety of surgeon expertise and experience. To help mitigate this variable experience, registry data such as the Nationwide Inpatient Sample (NIS) database can provide a snapshot as to what takes place across the country.…”

“…1 Although the role of laparoscopy for pathology of the rectum remains controversial, recent studies have continued to advocate for its wider application. [2][3][4][5] Laparoscopicassisted abdominoperineal resection (APR) was described as early as 1995. 6 Results have favored this approach; however, authors have cautioned against the use of laparoscopic APR until oncologic outcomes could be evaluated.…”