Exploring minimally invasive options: Laparoscopic transabdominal levator transection for low rectal cancers

Veerankutty, Fadl H; Chacko, Sidharth; Sreekumar, Vipin I; Krishnan, Prasad; Varma, Deepak; Kurumboor, Prakash

doi:10.4103/jmas.jmas_130_18

Cited by 3 publications

(3 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Since the implementation of LDAPR surgery in 2017, our team has found that individualised excision of the levator ani muscle under laparoscopic direct vision and avoiding the removal of the levator ani muscle through the perineal approach can reduce the damage to the nerve collateral caused by poor visual field. [ 22 ] Maximising the protection of the pelvic autonomic nerves related to urination and sexual function is also important in reducing the incidence of ITP and perineal complications. In addition, the confluent plane of the abdomen and perineum is reduced to the ischiorectal fossa fat, and the perineal surgery group can easily reach the same level as the abdominal group.…”

Section: Discussionmentioning

confidence: 99%

A short-term study of laparoscopic-dominant individualised levator ani resection in abdominoperineal resection: A retrospective investigation

Xue,

Jian,

Fang

et al. 2023

Journal of Minimal Access Surgery

View full text Add to dashboard Cite

Objective: The objective is to investigate if laparoscopic-dominant abdominoperineal resection (LDAPR) with individualised levator ani resection inhibits local recurrence (LR) and prolongs survival as compared to laparoscopic abdominoperineal resection (APR). Materials and Methods: Rectal cancer surgery cases were retrospectively identified from September 2014 to December 2019. LDAPR-treated group (55 patients) and the APR-treated group (71 patients) were included in the study. The operation time, circumferential resection margin (CRM), intraoperative tumor surgery (ITP), post-operative complications, the 2-year overall survival (OS) and LR were compared in the two groups. Results: The CRM and ITP were significantly reduced in the LDAPR as compared to the APR group (3.6% vs. 16.9%, t = 5.522, P = 0.019; 3.6% vs. 14.1%, t = 3.926, P = 0.048). In terms of post-operative complications, the incidence of urinary retention in LDAPR was significantly reduced than the APR group (10.9% vs. 25.4%, χ 2 = 4.139, P = 0.041). Similarly, perineal pain at 6 months or 1 year after surgery was significantly down-regulated in LDAPR than in the APR group (72.7% vs. 88.7%, χ 2 = 5.320, P = 0.021; 18.2% vs. 43.2%, χ 2 = 8.288, P = 0.004). However, there was no statistically significant difference in the post-operative complications between the LDAPR and APR groups. Finally, LDAPR led to a significantly improved 2-year OS and a reduced LR compared to APR. Conclusion: LDAPR reduces CMR, ITP and LR and simplified the perineum operation, subsequently protecting the pelvic autonomic nerves. Compared to the conventional APR, LDAPR is a promising procedure worth adopting for rectal cancer treatment.

show abstract

Section: Discussionmentioning

confidence: 99%

A short-term study of laparoscopic-dominant individualised levator ani resection in abdominoperineal resection: A retrospective investigation

Xue,

Jian,

Fang

et al. 2023

Journal of Minimal Access Surgery

View full text Add to dashboard Cite

show abstract

“…We had shown that as the experience of surgical team improved, there was a trend towards selecting difficult cases and performing complex laparoscopic colorectal resections. [ 18 19 ] In a study comprising 170 laparoscopic anterior resections Palanivelu C et al . concluded that laparoscopic anterior resections could be done for rectal tumours at all levels, which would allow sphincter preservation and maintain oncological safety.…”

Section: Discussionmentioning

confidence: 99%

Oncological adequacy of laparoscopic rectal cancer resection: An audit in Indian perspective

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background: Laparoscopic resection for rectal cancer (LRR) has gained popularity because of better short-term outcomes and less post-operative morbidity. However, LRR is still not endorsed as a standard of care mainly due to concerns centred on oncological safety in comparison with open approach. Moreover, two recent randomised trials (Australian Laparoscopic Cancer of the Rectum [ALaCaRT] and the American College of Surgeons Oncology Group [ACOSOG] Z6051) have failed to prove that LRR is non-inferior to open resection. Studies on oncological adequacy of LRR in the Indian population in terms of quality of mesorectal excision are scarce. In this article, we aim to audit the oncological adequacy of LRR in our centre and thereby critically analyse the reliability of extrapolation of results of ALaCaRT and ACOSOG trials to the Indian population. Methods: We retrospectively analysed the oncological adequacy of LRR in terms of completeness of total mesorectal excision (TME), distal and circumferential resection margin (CRM) status and nodal harvest in patients with rectal cancer who underwent LRR between January 2016 and June 2018 at our centre. Results: Of 157 patients included in this study, a complete TME was achieved in 148 (94.26%) patients and nearly complete in 7 (4.46%) patients. A safe CRM (≥1 mm) was obtained in 151 (96.18%) patients. Distal margin results were negative in 155 (98.73%) patients. Average nodal harvest was 19.86 ± 9.28. Overall surgical success, calculated as a composite measure of negative distal margin and negative CRM and complete TME was 95.54%. Conclusion: Good quality rectal cancer resection can be achieved by experienced laparoscopic surgeons without compromising oncological safety.

show abstract

“…These include airway complications (endotracheal tube displacement), oropharyngeal swelling, acute glaucoma, optical compartment syndrome, cardiovascular compromise and neurological injuries ( 22 ). These problems with ELAPE were acknowledged and a subsequent modification of the ELAPE technique, termed laparoscopic transabdominal ELAPE, removed the need for position change to a prone position and so reduced patient morbidity and operating times ( 23 ).…”

Section: Drawbacks Of the New Techniquementioning

confidence: 99%

Surgical Techniques for Abdominoperineal Resection for Rectal Cancer: One Size Does Not Fit All

et al. 2022

View full text Add to dashboard Cite

Abdominoperineal resection (APR) of rectal cancer is associated with poorer oncological outcomes than anterior resection. This may be due to higher rates of intra-operative perforation (IOP) and circumferential resection margin (CRM) involvement causing higher recurrence rates and surgical complications. To address these concerns, several centers advocated a change in technique from a standard APR to a more radical extra-levator abdominoperineal excision (ELAPE). Initial reports showed that ELAPE reduced IOP rates and CRM involvement but increased wound complications and longer surgical duration. However, many of these studies had unacceptable rates of IOP and CRM before retraining in ELAPE. This may indicate that it was a sub-optimal surgical technique, which improved upon training, that had influenced the high CRM and IOP rates rather than the technique itself. Subsequent studies demonstrated that the CRM involvement rate for ELAPE was not always lower than for standard APR and, in some cases, significantly higher. The morbidity of ELAPE can be high, with studies reporting higher adverse events than APR, especially in terms of wound complications from the larger perineal incision required in ELAPE. Whether ELAPE improves short- or long-term oncological outcomes for patients has not been clearly demonstrated. The authors propose that all centers performing rectal cancer surgery audit surgical outcomes of patients undergoing APR or ELAPE and examine CRM involvement, IOP rates, and local recurrence rates, preferably through a national body. If rates of adverse technical or oncological outcomes exceed acceptable levels, then retraining in the appropriate surgical techniques may be indicated.

show abstract

Exploring minimally invasive options: Laparoscopic transabdominal levator transection for low rectal cancers

Cited by 3 publications

References 6 publications

A short-term study of laparoscopic-dominant individualised levator ani resection in abdominoperineal resection: A retrospective investigation

A short-term study of laparoscopic-dominant individualised levator ani resection in abdominoperineal resection: A retrospective investigation

Oncological adequacy of laparoscopic rectal cancer resection: An audit in Indian perspective

Surgical Techniques for Abdominoperineal Resection for Rectal Cancer: One Size Does Not Fit All

Contact Info

Product

Resources

About