Conventional approach x laparoscopic abdominoperineal resection for rectal cancer treatment after neoadjuvant chemoradiation: results of a prospective randomized trial

Abstract

OBJECTIVE:The aims of this study were to evaluate the safety and efficacy of laparoscopic abdominoperineal resection compared to conventional approach for surgical treatment of patients with distal rectal cancer presenting with incomplete response after chemoradiation.METHOD: Twenty eight patients with distal rectal adenocarcinoma were randomized to undergo surgical treatment by laparoscopic abdominoperineal resection or conventional approach and evaluated prospectively. Thirteen underwent laparoscopic abdominoperineal resection and 15 conventional approach .RESULTS: There was no significant difference (p<0,05) between the two studied groups regarding: gender, age, body mass index, patients with previous abdominal surgeries, intra and post operative complications, need for blood transfusion, hospital stay after surgery, length of resected segment and pathological staging. Mean operation time was 228 minutes for the laparoscopic abdominoperineal resection versus 284 minutes for the conventional approach (p=0.04). Mean anesthesia duration was shorter (p=0.03) for laparoscopic abdominoperineal resection when compared to conventional approach : 304 and 362 minutes, respectively. There was no need for conversion to open approach in this series. After a mean follow-up of 47.2 months and with the exclusion of two patients in the conventional abdominoperineal resection who presented with unsuspected synchronic metastasis during surgery, local recurrence was observed in two patients in the conventional group and in none in the laparoscopic group.CONCLUSIONS: We conclude that laparoscopic abdominoperineal resection is feasible, similar to conventional approach concerning surgery duration, intra operative morbidity, blood requirements and post operative morbidity. Larger number of cases and an extended follow-up are required to adequate evaluation of oncological results for patients undergoing laparoscopic abdominoperineal resection after chemoradiation for radical treatment of distal rectal cancer.

Laparoscopic Colonic Resection for Rectosigmoid Colonic Tumours: A Retrospective Analysis and Comparison with Open Resection

“…The operating time for LAC group was more, though statistically not significant, compared to the OR group (297 versus 180 minutes). This has been observed in other series as well [4,6,13,14]. A meta-analysis of the large randomized trials has shown a conversion rate of 19% [16].…”

“…Despite this, the better short term recovery of the LAC group could be demonstrated by the fewer days spent in the ICU and shorter hospital stay. This has been demonstrated in most of the other series as well [5,[10][11][12][13][14]16].…”

“…This is reflected by the fact that many large multicenter trials except MRC-CLASSIC have not included patients with rectal cancer [9]. However, there are 5 randomized trials published till date and that have demonstrated comparable short term outcome of laparoscopic and open surgery [4,6,[9][10][11][12][13][14][15]. Our study also shows comparable short term outcome of the LAC group with relatively early recovery following surgery.…”

“…The number of lymph nodes cleared, the number of patients with positive resection margins etc were similar in both the groups. This has been the experience in most large trials as well [4,6,13,14]. Moreover, the long term results of multicentre randomised trials like COST, CLASSIC and COLOR have demonstrated equal disease free and overall survival for colorectal cancer treated by laparoscopy compared to open surgery [14,15,17].…”

Metastatic lymph node ratio as a prognostic factor after laparoscopic total mesorectal excision for extraperitoneal rectal cancer

“…Evidence comes mainly from several case series [4,[10][11][12], comparative nonrandomized studies [13][14][15], or randomized clinical trials (RCTs) [16][17][18][19][20][21] with a limited number of patients or a relatively short follow-up period.…”