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01-09-2007

Laparoscopic vs. Open Total Mesorectal Excision in Unselected Patients with Rectal Cancer: Impact on Early Outcome

Authors: Carlo Staudacher, M.D., Andrea Vignali, M.D., Di Palo Saverio, M.D., Orsenigo Elena, M.D., Tamburini Andrea, M.D.

Published in: Diseases of the Colon & Rectum | Issue 9/2007

Purpose

This study was designed to compare laparoscopic vs. open total mesorectal excision for cancer of the rectum on perioperative outcome and quality of life.

Methods

A total of 187 consecutive unselected patients with rectal cancer who underwent total mesorectal excision during a seven-year period were prospectively evaluated. Patients were monitored 30 days for postoperative complications. Quality of life was evaluated before and at one year after surgery.

Results

A total of 108 patients underwent laparoscopic total mesorectal excision, whereas 79 underwent open. Conversion rate was 12 percent. In the laparoscopic group, operating time was 33 minutes longer (P = 0.03) and intraoperative blood loss was lower (P = 0.001). Tumor stage and the number of lymph nodes that were intraoperatively collected were similar in the two groups. The overall morbidity rate was 29.6 percent in the laparoscopic and 27.8 percent in the open (P = 0.78) group. No patient died during the postoperative period. Anastomotic leak rate was similar in the two groups (14.8 percent in laparoscopic vs. 12.6 percent in open; P = 0.88). Patients in the laparoscopic group recovered earlier bowel function (P = 0.01) and experienced a shorter length of stay (P = 0.003). At one-year follow-up, overall quality of life was similar in the two groups. In the laparoscopic group, social functioning item was significantly better (P = 0.05) and trend to a better physical status was observed (P = 0.07).

Conclusions

Laparoscopic total mesorectal excision is safe and feasible, does not jeopardize the complication rate, and has the benefits of much less blood during the operation and shorter hospitalization.

Abraham, NS, Young, JM, Solomon, MJ 2004Meta-analysis of short term outcomes after laparoscopic resection for colorectal cancerBr J Surg9111111124PubMedCrossRef

Vignali, A, Braga, M, Zuliani, W, Frasson, M, Radaelli, G, Carlo, V 2004Laparoscopic colorectal surgery modifies risk factors for postoperative morbidityDis Colon Rectum4716861693PubMedCrossRef

Milsom, JW, Bohm, B, Hammerhoffer, KA, Fazio, VW, Steiger, E, Elson, P 1998A prospective randomized trial comparing laparoscopic vs conventional techniques in colorectal cancer surgery. A preliminary reportJ Am Coll Surg1874657PubMedCrossRef

Braga, M, Vignali, A, Gianotti, L, et al. 2002Laparoscopic versus open colorectal surgery. A randomized trial on short-term outcomeAnn Surg236759767PubMedCrossRef

Nelson, H, Sargent, DJ, Wieand, HS, et al. 2004A comparison of laparoscopically assisted and open colectomy for colon cancerN Engl J Med35020502059CrossRef

Hazebroek, EJ 2002COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancerSurg Endosc16949953PubMedCrossRef

Leung, KL, Kwok, SP, Lam, SC, et al. 2004Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trialLancet36311871192PubMedCrossRef

Guillou, P, Quirke, P, Thorpe, H, et al. 2005Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer: multicentre, randomized controlled trialLancet36517181726PubMedCrossRef

Lacy, AM, Garcia-Valdecasas, JC, Delgado, S, et al. 2002Laparoscopic-assisted colectomy vs open colectomy for treatment of non-metastatic colon cancer: a randomized trialLancet35922242229PubMedCrossRef

10.

Wu, WX, Sun, YM, Hua, YB, Shen, LZ 2004Laparoscopic versus conventional open resection of rectal carcinoma: a clinical comparative studyWorld J Gastroenterol1011671170PubMed

11.

Hartley, JE, Mehigan, BJ, Akhtar, EQ, et al. 2001Total mesorectal excision: assessment of the laparoscopic approachDis Colon Rectum44315321PubMedCrossRef

12.

Morino, M, Parini, U, Girando, G, Micky, S, Brachet Contul, R, Garrone, C 2003Laparoscopic total mesorectal excision: a consecutive series of 100 patientsAnn Surg237335342PubMedCrossRef

13.

Rullier, E, Cunha, AS, Coudere, P, Rullier, A, Gontier, R, Saric, J 2003Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancerBr J Surg90445451PubMedCrossRef

14.

Leroy, J, Jamali, F, Forbes, L, et al. 2004Laparoscopic total mesorectal excision (TME) for rectal cancer surgery. Long-term outcomesSurg Endosc18281289PubMedCrossRef

15.

Kim, SH, Park, IJ, Joh, YG, Hahn, KY 2006Laparoscopic resection for rectal cancer: a prospective analysis of thirty-month follow-up outcomes in 312 patientsSurg Endosc2011971202PubMedCrossRef

16.

Kitano, S, Kitajima, M, Konishi, F, et al. 2006A multicenter study on laparoscopic surgery for colorectal cancer in JapanSurg Endosc2013481352PubMedCrossRef

17.

Vignali, A, Palo, S, Tamburini, A, Radaelli, G, Orsenigo, E, Staudacher, C 2005Laparoscopic vs. open colectomies in octogenarians: a case-matched control studyDis Colon Rectum4820702075PubMedCrossRef

18.

Heald, RJ, Hyall, RD 1986Recurrence and survival after total mesorectal excision for rectal cancerLancet2814791482CrossRef

19.

Vignali, A, Fazio, VW, Lavery, IC, et al. 1997Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patientsJ Am Coll Surg185113121

20.

Ware, JE,Jr, Shelbourne, CD 1992The MOS 36-item short-form health survey (SF-36). Conceptual framework and item selectionMed Care30473483PubMedCrossRef

21.

Rauch, P, Miny, J, Conroy, T, Neyton, L, Guillemin, F 2004Quality of life among disease-free survivors of rectal cancerJ Clin Oncol22354360PubMedCrossRef

22.

Braga, M, Frasson, M, Vignali, A, Zuliani, W, Civelli, V, Carlo, V 2005Laparoscopic vs. open colectomy in cancer patients: long-term complications, quality of life and survivalDis Colon Rectum4822172223PubMedCrossRef

23.

Breukink, S, Pierie, J, Wiggers, T 2006Laparoscopic versus total mesorectal excision for rectal cancerCochrane Database Syst Rev4142

24.

Gonzales, AI, Diaz, LH, Malagon, MA, et al. 2006A comparative clinical study of short-term results of laparoscopic surgery for rectal cancer during the learning curveInt J Colorectal Dis21590595CrossRef

25.

Morino, M, Allaix, ME, Girando, F, Corno, F, Garrone, C 2005Laparoscopic versus open surgery for extraperitoneal rectal cancerSurg Endosc1914601467PubMedCrossRef

26.

Law, WL, Lee, MY, Choi, HK, Seto, CL, Ho, JW 2006Laparoscopic and open anterior resection for upper and mid rectal cancer: an evaluation of outcomesDis Colon Rectum4911081115PubMedCrossRef

27.

Marescaux, J, Rubino, F, Leroy, J 2005Laparoscopic total mesorectal excision for rectal cancer surgeryDig Dis23135141PubMedCrossRef

28.

Delgado, S, Momblan, D, Salvador, L, et al. 2004Laparoscopic-assisted approach in rectal cancer patients. Lesson learned from > 200 patientsSurg Endosc1814571462PubMedCrossRef

29.

Tsang, WW, Chung, CC, Kwok, SY, Li, MK 2006Laparoscopic sphincter-preserving total mesorectal excision with colonic j-pouch reconstruction. Five year resultsAnn Surg243353358PubMedCrossRef

30.

Aziz, O, Costantinides, V, Tekkis, P, et al. 2006Laparoscopic versus open surgery for rectal cancer: a meta-analysisAnn Surg Oncol13413424PubMedCrossRef

31.

Edwards, DP, Leppington-Clarke, A, Sexton, R, Heald, RJ, Moran, BJ 2001Stoma-related complications are more frequent after transverse colostomy than loop ileostomy: a prospective randomised trialBr J Surg88360363PubMedCrossRef

32.

Law, WL, Chu, KW, Choi, HK 2002Randomized clinical trial comparing loop ileostomy and loop transverse colostomy for faecal diversion following total mesorectal excisionBr J Surg89704708PubMedCrossRef

33.

Pachler, J, Wille-Jorgensen, P 2005Quality of life in patients after rectal resection for cancer with or without permanent colostomy (review)Cochrane Database Syst Rev2120

34.

Camilleri-Brennan, J, Steele, RJ 2001Prospective analysis of quality of life and survival following mesorectal excision for rectal cancerBr J Surg8816171622PubMedCrossRef

35.

Arndt, V, Merx, H, Stegmaier, C, Ziegler, H, Brenner, H 2004Quality of life in patients with colorectal cancer 1 year after diagnosis compared with general population: a population-based studyJ Clin Oncol2248294836PubMedCrossRef

36.

Sultan, S, Fisher, DA, Voils, CI, Kinney, AY, Sancler, RS, Provenzale, D 2004Impact of quality of functional support on health-related quality of life in patients with colorectal cancerCancer10127372743PubMedCrossRef

37.

Schmidt, CE, Bestmann, B, Kuchler, T, Longo, WE, Rohde, V, Kremer, B 2005Gender differences in quality of life of patients with rectal cancer. A five-year prospective studyWorld J Surg2916301641PubMedCrossRef

Title: Laparoscopic vs. Open Total Mesorectal Excision in Unselected Patients with Rectal Cancer: Impact on Early Outcome
Authors: Carlo Staudacher, M.D.
Andrea Vignali, M.D.
Di Palo Saverio, M.D.
Orsenigo Elena, M.D.
Tamburini Andrea, M.D.
Publication date: 01-09-2007
Publisher: Springer-Verlag
Published in: Diseases of the Colon & Rectum / Issue 9/2007
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI: https://doi.org/10.1007/s10350-007-0289-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Laparoscopic vs. Open Total Mesorectal Excision in Unselected Patients with Rectal Cancer: Impact on Early Outcome

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Purpose

Methods

Results

Conclusions

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