Laparoscopic Resection of Rectal Cancer Results in Higher Lymph Node Yield and Better Short-term Outcomes Than Open Surgery

Boutros, Marylise; Hippalgaonkar, Neha; Silva, Emanuela; Allende, Daniela S.; Wexner, Steven D.; Berho, Mariana

doi:10.1097/dcr.0b013e318287c594

Cited by 43 publications

(29 citation statements)

References 38 publications

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“…Oncological results too are acceptable with a CRM positivity rate of 4% for sphincter saving resections (4 out of 106 patients) and 18% for APER (5 out of 27 patients). LNH was higher following laparoscopic resection, in keeping with other studies[16]. …”

Section: Discussionsupporting

confidence: 92%

Value of multi-disciplinary input into laparoscopic management of rectal cancer - An observational study

Rao¹,

Peiris²,

Arif³

et al. 2017

WJGS

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AIMTo assess the impact of multi-disciplinary teams (MDTs) management in optimising the outcome for rectal cancers.METHODSWe undertook a retrospective review of a prospectively maintained database of patients with rectal cancers (defined as tumours ≤ 15 cm from anal verge) discussed at our MDT between Jan 2008 and Jan 2011. The data was validated against the national database to ensure completeness of dataset. The clinical course and follow-up data was validated using the institution’s electronic patient records. The data was analysed in terms of frequencies and percentages. Significance of any differences were analysed using χ2 test. A Kaplan-Meier analysis was performed for overall survival and disease free survival.RESULTSFollowing appropriate staging, one hundred and thirty-three patients were suitable for potentially curative resections. Seventy two (54%) were upper rectal cancer (URC) - tumour was > 6 cm from the anal verge and 61 (46%) were lower rectal cancers (LRC) - lower extent of the tumour was palpable ≤ 6 cm. Circumferential resection margin (CRM) appeared threatened on pre-operative MRI in 19/61 (31%) patients with LRC requiring neo-adjuvant therapy (NAT). Of the 133 resections, 118 (89%) were attempted laparoscopically (5% conversion rate). CRM was positive in 9 (6.7%) patients; Median lymph node harvest was 12 (2-37). Major complications occurred in 8 (6%) patients. Median follow-up was 53 mo (0-82). The 90-d mortality was 2 (1.5%). Over the follow-up period, disease related mortality was 11 (8.2%) and overall mortality was 39 (29.3%). Four (3%) patients had local recurrence and 22 (16.5%) patients had distant metastases.CONCLUSIONManagement of rectal cancers can be optimized with multi-disciplinary input to attain acceptable long-term oncological outcomes even when incorporating a laparoscopic approach to rectal cancer resection.

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Section: Discussionsupporting

confidence: 92%

Value of multi-disciplinary input into laparoscopic management of rectal cancer - An observational study

Rao¹,

Peiris²,

Arif³

et al. 2017

WJGS

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“…The ACOSOG Z6051 trial had one of the highest rates of complete or nearly complete TME for the laparoscopic approach (92%), with a relatively low rate of conversion (11%); however due to the non-statistically validated composite end point, it has failed to demonstrate non-inferiority of laparoscopy compared with the open approach [25]. Moreover, the authors have proven superior oncological outcomes using laparoscopy [33]. …”

Section: Adoption Rates For the Laparoscopic Approachmentioning

confidence: 99%

Re-appraisal and consideration of minimally invasive surgery in colorectal cancer

Gazala

Wexner

2017

Gastroenterology Report

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Throughout history, surgeons have been on a quest to refine the surgical treatment options for their patients and to minimize operative trauma. During the last three decades, there have been tremendous advances in the field of minimally invasive colorectal surgery, with an explosion of different technologies and approaches offered to treat well-known diseases. Laparoscopic surgery has been shown to be equal or superior to open surgery. The boundaries of laparoscopy have been pushed further, in the form of single-incision laparoscopy, natural-orifice transluminal endoscopic surgery and robotics. This paper critically reviews the pathway of development of minimally invasive surgery, and appraises the different minimally invasive colorectal surgical approaches available to date.

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“…Despite these encouraging results, the adoption of laparoscopy in colorectal surgery has been slow. 3 The right laparoscopic hemicolectomy procedures have produced conflicting reports. The reasons could be because of variable and complex anatomy on right side with different procedures like right, extended right hemicolectomy and transverse colectomy.…”

Section: Introductionmentioning

confidence: 99%

Comparison of short-term outcomes following open and laparoscopic resections for colorectal malignancies

Keerthi¹,

Shankar²,

Ganesh³

et al. 2017

Int J Res Med Sci

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Background: The laparoscopic approach for colorectal cancers are still a matter of controversy. In the present study, we tried to compare the laparoscopy with open methods of colorectal resections.Methods: Retrospective study where patients diagnosed with colorectal cancer in our hospital from year 2014 January to December 2016 were taken. Total number of cases were 69 of which, the total number of right colon cases were 26. Out of twenty-six, 12 underwent open procedure and 14 underwent laparoscopic resections. Total number of left colon cancers were 09. Of these, 2 underwent open and 7 underwent laparoscopic procedure. Thirty-four (34) rectal cancers were included in the study. Of these, 12 underwent open rectal procedures and 22 underwent laparoscopic resections. Multiple parameters like duration of surgery, post-operative complications, postoperative stay, pathological T staging, lymph node yield, positive nodes, distal resection margins, circumferential radial margins were compared.Results: Operating time was significantly shorter in open procedure than laparoscopic surgery in both rectal resection and right hemicolectomies. The postoperative stay was significantly shorter in laparoscopic right hemicolectomy compared to open procedure. All other parameters like post-operative complications, T stage, lymph node yield, positive nodes, distal resection margins and CRMs were comparable in both groups. The lymph node yield was similar in upfront and post neoadjuvant carcinoma rectum cases.Conclusions: Laparoscopic colorectal resections have similar rates of complication, with shorter hospital stays with no compromise on oncological clearance with respect to lymph node yield, CRMs, distal resection margins compared to open procedures.

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Laparoscopic Resection of Rectal Cancer Results in Higher Lymph Node Yield and Better Short-term Outcomes Than Open Surgery

Abstract: Laparoscopy for primary rectal cancer is associated with a greater number of lymph nodes as well as short-term benefits.

Cited by 43 publications

References 38 publications

Value of multi-disciplinary input into laparoscopic management of rectal cancer - An observational study

Value of multi-disciplinary input into laparoscopic management of rectal cancer - An observational study

Re-appraisal and consideration of minimally invasive surgery in colorectal cancer

Comparison of short-term outcomes following open and laparoscopic resections for colorectal malignancies

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