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Surgical Endoscopy

Published in:

01-11-2010

Introduction of laparoscopic low anterior resection for rectal cancer early during residency: a single institutional study on short-term outcomes

Authors: Satoshi Ogiso, Takashi Yamaguchi, Hiroaki Hata, Hiroya Kuroyanagi, Yoshiharu Sakai

Published in: Surgical Endoscopy | Issue 11/2010

Abstract

Background

Laparoscopic surgery for rectal cancer is unpopular because it is technically challenging. Suitable training systems have not been widely studied or established despite the steep learning curve for this procedure. We developed a systematic training program that enables resident surgeons to perform laparoscopic low anterior resection (LLAR) for rectal cancer and evaluated the safety and feasibility of this training program.

Methods

We analyzed prospectively gathered data on all LLARs for rectal cancer performed at a single center over a 7-year period. Patients were assessed for demographic characteristics, tumor characteristics, operative procedure, operative time, blood loss, conversion to open surgery, complications, time to bowel recovery, distal margin, and number of lymph nodes harvested. We compared the early surgical, oncological, and functional outcomes of LLARs performed by expert surgeons with those of LLARs performed by resident surgeons for both intraperitoneal and extraperitoneal rectal cancer. All analyses were performed on an intention-to-treat basis.

Results

A total of 137 patients met the inclusion criteria for this study. Of the 75 LLARs for intraperitoneal rectal cancer, 40 were performed by expert surgeons (I-E group) and 35 by resident surgeons (I-R group). Of the 62 LLARs for extraperitoneal rectal caner, 51 were performed by expert surgeons (E-E group) and 11 by resident surgeons (E-R group). The operative time was longer in the E-R group than in the E-E group. The time to resumption of diet was longer in the I-E group than in the I-R group. The other early outcomes, including blood loss, anastomotic leakage, conversion to open surgery, and number of lymph nodes harvested, were similar in the I-E and I-R groups and in the E-E and E-R groups.

Conclusion

Our systematic training program on LLAR for rectal cancer enables resident surgeons to perform this procedure safely early during residency, with acceptable short-term outcomes.

Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 363:1187–1192CrossRefPubMed

Law WL, Lee YM, Choi HK, Seto CL, Ho JW (2006) Laparoscopic and open anterior resection for upper and mid rectal cancer: an evaluation of outcomes. Dis Colon Rectum 49:1108–1115CrossRefPubMed

Morino M, Allaix ME, Giraudo G, Corno F, Garrone C (2005) Laparoscopic versus open surgery for extraperitoneal rectal cancer: a prospective comparative study. Surg Endosc 19:1460–1467CrossRefPubMed

Braga M, Frasson M, Vignali A, Zuliani W, Civelli V, Di Carlo V (2005) Laparoscopic vs. open colectomy in cancer patients: long-term complications, quality of life, and survival. Dis Colon Rectum 48:2217–2223CrossRefPubMed

Zhou ZG, Hu M, Li Y, Lei WZ, Yu YY, Cheng Z, Li L, Shu Y, Wang TC (2004) Laparoscopic versus open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc 18:1211–1215CrossRefPubMed

Ströhlein MA, Grützner KU, Jauch KW, Heiss MM (2008) Comparison of laparoscopic vs. open access surgery in patients with rectal cancer: a prospective analysis. Dis Colon Rectum 51:385–391CrossRefPubMed

Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, Heath RM, Brown JM, UK MRC CLASICC Trial Group (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068CrossRefPubMed

Kuhry E, Schwenk W, Gaupset R, Romild U, Bonjer J (2008) Long-term outcome of laparoscopic surgery for colorectal cancer: a Cochrane systematic review of randomised controlled trials. Cancer Treat Rev 34:498–504CrossRefPubMed

Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC Trial Group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726CrossRefPubMed

10.

Rattner DW, Apelgren KN, Eubanks WS (2001) The need for training opportunities in advanced laparoscopic surgery. Surg Endosc 15:1066–1070CrossRefPubMed

11.

Park A, Witzke D, Donnelly M (2002) Ongoing deficits in resident training for minimally invasive surgery. J Gastrointest Surg 6:501–507CrossRefPubMed

12.

Schijven MP, Berlage JT, Jakimowicz JJ (2004) Minimal-access surgery training in the Netherlands: a survey among residents-in-training for general surgery. Surg Endosc 18:1805–1814CrossRefPubMed

13.

Lin E, Szomstein S, Addasi T, Galati-Burke L, Turner JW, Tiszenkel HI (2003) Model for teaching laparoscopic colectomy to surgical residents. Am J Surg 186:45–48CrossRefPubMed

14.

Chautard J, Alves A, Zalinski S, Bretagnol F, Valleur P, Panis Y (2008) Laparoscopic colorectal surgery in elderly patients: a matched case-control study in 178 patients. J Am Coll Surg 206:255–260CrossRefPubMed

15.

Frasson M, Braga M, Vignali A, Zuliani W, Di Carlo V (2008) Benefits of laparoscopic colorectal resection are more pronounced in elderly patients. Dis Colon Rectum 51:296–300CrossRefPubMed

16.

Scheidbach H, Schneider C, Konradt J, Bärlehner E, Köhler L, Wittekind Ch, Köckerling F (2002) Laparoscopic abdominoperineal resection and anterior resection with curative intent for carcinoma of the rectum. Surg Endosc 16:7–13CrossRefPubMed

17.

Bärlehner E, Benhidjeb T, Anders S, Schicke B (2005) Laparoscopic resection for rectal cancer: outcomes in 194 patients and review of the literature. Surg Endosc 19:757–766CrossRefPubMed

18.

Dulucq JL, Wintringer P, Stabilini C, Mahajna A (2005) Laparoscopic rectal resection with anal sphincter preservation for rectal cancer: long-term outcome. Surg Endosc 19:1468–1474CrossRefPubMed

19.

Polliand C, Barrat C, Champault G (2005) Laparoscopic resection of low rectal cancer with a mean follow-up of seven years. Surg Laparosc Endosc Percutan Tech 15:144–148CrossRefPubMed

20.

Kuroyanagi H, Oya M, Ueno M, Fujimoto Y, Yamaguchi T, Muto T (2008) Standardized technique of laparoscopic intracorporeal rectal transection and anastomosis for low anterior resection. Surg Endosc 22:557–561CrossRefPubMed

21.

Pugliese R, Di Lernia S, Sansonna F, Scandroglio I, Maggioni D, Ferrari GC, Costanzi A, Magistro C, De Carli S (2008) Results of laparoscopic anterior resection for rectal adenocarcinoma: retrospective analysis of 157 cases. Am J Surg 195:233–238CrossRefPubMed

22.

Kim SH, Park IJ, Joh YG, Hahn KY (2008) Laparoscopic resection of rectal cancer: a comparison of surgical and oncologic outcomes between extraperitoneal and intraperitoneal disease locations. Dis Colon Rectum 51:844–851CrossRefPubMed

23.

Bianchi PP, Rosati R, Bona S, Rottoli M, Elmore U, Ceriani C, Malesci A, Montorsi M (2007) Laparoscopic surgery in rectal cancer: a prospective analysis of patient survival and outcomes. Dis Colon Rectum 50:2047–2053CrossRefPubMed

24.

Feliciotti F, Guerrieri M, Paganini AM, De Sanctis A, Campagnacci R, Perretta S, D’Ambrosio G, Lezoche E (2003) Long-term results of laparoscopic versus open resections for rectal cancer for 124 unselected patients. Surg Endosc 17:1530–1535CrossRefPubMed

25.

Milsom JW, de Oliveira O, Trencheva KI Jr, Pandey S, Lee SW, Sonoda T (2009) Long-term outcomes of patients undergoing curative laparoscopic surgery for mid and low rectal cancer. Dis Colon Rectum 52:1215–1222PubMed

26.

Tytherleigh M, Wheeler J, Birks M, Farouk R (2002) Surgical specialist registrars can safely perform resections for carcinoma of the rectum. Ann R Coll Surg Engl 84:389–392CrossRefPubMed

27.

Renwick AA, Bokey EL, Chapuis PH, Zelas P, Stewart PJ, Rickard MJ, Dent OF (2005) Effect of supervised surgical training on outcomes after resection of colorectal cancer. Br J Surg 92:631–636CrossRefPubMed

28.

Mehall JR, Shroff S, Fassler SA, Harper SG, Nejman JH, Zebley DM (2005) Comparing results of residents and attending surgeons to determine whether laparoscopic colectomy is safe. Am J Surg 189:738–741CrossRefPubMed

29.

Bencini L, Bernini M, Martini F, Rossi M, Farsi M, Boffi B, Miranda E, Moraldi L, Moretti R (2008) Safety of laparoscopic cholecystectomy performed by surgical residents. Chir Ital 60:819–824PubMed

30.

Böckler D, Geoghegan J, Klein M, Weissmann Q, Turan M, Meyer L, Scheele J (1999) Implications of laparoscopic cholecystectomy for surgical residency training. JSLS 3:19–22PubMed

Title: Introduction of laparoscopic low anterior resection for rectal cancer early during residency: a single institutional study on short-term outcomes
Authors: Satoshi Ogiso
Takashi Yamaguchi
Hiroaki Hata
Hiroya Kuroyanagi
Yoshiharu Sakai
Publication date: 01-11-2010
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 11/2010
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-010-1057-3

At a glance: The STEP trials

Springer Medicine

Introduction of laparoscopic low anterior resection for rectal cancer early during residency: a single institutional study on short-term outcomes

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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