Top

International Journal of Colorectal Disease

Published in:

01-09-2005 | Original Article

Laparoscopic versus open total mesorectal excision: a case-control study

Authors: S. O. Breukink, J. P. E. N. Pierie, A. J. K. Grond, C. Hoff, T. Wiggers, W. J. H. J. Meijerink

Published in: International Journal of Colorectal Disease | Issue 5/2005

Abstract

Background and aims

Because definitive long-term results are not yet available, the oncological safety of laparoscopic surgery for treatment of rectal cancer remains unproven. The aim of this prospective non-randomised study was to assess the feasibility and short-term outcome of laparoscopic total mesorectal excision (LTME) after 25–30 Gy preoperative radiotherapy and to compare the results with a matched-control group of open TME (OTME).

Materials and methods

A series of 41 patients with primary rectal cancer underwent LTME for rectal cancer and were matched with a historical control group of 41 patients who underwent OTME. Both groups received preoperative short-term radiotherapy.

Results

There was no mortality in the LTME group and 2% mortality in the OTME group. The overall postoperative morbidity was 37% in the LTME group and 51% in the OTME group, including an anastomotic leakage of 9 and 14% in the LTME and OTME groups respectively. A positive circumferential margin was found in 7% of patients in the LTME group and in 12% of the patients in the OTME group.

Conclusion

This study shows that LTME is technically feasible and can be performed safely. We show at least a similar surgical completeness using a laparoscopic technique compared with open surgery.

Milsom JW, Bohm B, Hammerhofer KA et al (1998) A prospective randomised trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: preliminary report. J Am Coll Surg 187:46–57CrossRefPubMed

Schwander O, Schiedeck THK, Killaitis C et al (1999) A case control study comparing laparoscopic versus open surgery for rectosigmoid and rectal cancer. Int J Colorectal Dis 14:158–163CrossRefPubMed

Seow-Choen F, Eu KW, Yo JH et al (1997) A preliminary comparison of a consecutive series of open versus laparoscopic abdomino-perineal resection for rectal adenocarcinoma. Int J Colorectal Dis 12:88–90CrossRef

Ramos JR, Petrosemolo RH, Valory EA et al (1997) Abdomino-perineal resection: laparoscopic versus conventional. Surg Laparosc Endosc 7:148–152CrossRef

Fleshman JW, Wexner SD, Anvari M et al (1999) Laparoscopic vs. open abdomino-perineal resection for cancer. Dis Colon Rectum 42:930–939PubMed

Wexner SD, Cohen SM (1995) Port site metastases after laparoscopic colorectal surgery for cure of malignancy. Br J Surg 82:295–298PubMed

Heald RJ, Ryall RDH (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482CrossRefPubMed

Kapteijn E, Marijnen CAM, Nagtegaal ID et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646CrossRefPubMed

Rullier E, Cunha A, Couderc P et al (2003) Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer. Br J Surg 90:445–451CrossRefPubMed

10.

Morino M, Parini U, Giraudo G et al (2003) Laparoscopic total mesorectal excision. Ann Surg 3:335–342

11.

Quirke P, Durdey P, Dixon MF et al (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection: histopathological study of lateral tumor spread and surgical excision. Lancet 2:996–999CrossRefPubMed

12.

Nagtegaal ID, Marijnen CAM, Kranenberg EK et al (2002) Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma. Am J Surg Pathol 26:350–357CrossRefPubMed

13.

Marijnen CAM, Kapiteijn E, van der Velde CJH et al (2002) Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer. J Clin Oncol 20:817–825

14.

Decanini C, Milsom JW, Böhm B et al (1994) Laparoscopic oncologic abdomino-perineal resection. Dis Colon Rectum 37:552–558PubMed

15.

Scheidbach H, Schneider C, Konradt J et al (2002) Laparoscopic abdomino-perineal resection and anterior resection with curative intent for carcinoma of the rectum. Surg Endosc 16:7–13

16.

Yamamoto S, Watanabe M, Hirotoshi H et al (2002) Prospective evaluation of laparoscopic surgery for rectosigmoidal and rectal carcinoma. Dis Colon Rectum 45:1648–1654PubMed

17.

Tsang WWC, Chung CC, Li MKW (2003) Prospective evaluation of laparoscopic total mesorectal excision with colonic J-pouch reconstruction for mid and low rectal cancers. Br J Surg 90:867–871

18.

Carlen E, Schlichting E, Guldvol I et al (1998) Effect of the introduction of total mesorectal excision for the treatment of rectal cancer. Br J Surg 85:526–529CrossRefPubMed

19.

Heald RJ, Moran BJ, Ryall RDH et al (1998) Rectal cancer: the Basingstoke experience of total mesorectal excision, 1987–1997. Arch Surg 133:894–899CrossRefPubMed

20.

Wibe A, Rendedal PR, Svensson E et al (2002) Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg 89:327–334

21.

Birbeck KF, Macklin CP, Tiffin NJ et al (2002) Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg 4:449–457

22.

Hartley JE, Mehigan BJ, Qureshi AE et al (2001) Total mesorectal excision: assessment of the laparoscopic approach. Dis Colon Rectum 44:315–321PubMed

23.

Sobin LH, Greene FL (2001) TNM classification: clarification of number of regional lymph nodes for pNo. Cancer 92:452

24.

Marijnen CAM, Nagtegal ID, Kranenbarg EK et al (2001) No downstaging after short-term preoperative radiotherapy in rectal cancer patients. J Clin Oncol 19:1976–1984

25.

Rodrigues-Bigas MA, Maamoun S, Weber TK et al (1996) Clinical significance of colorectal cancer: metastases in lymph nodes <5 mm in size. Ann Surg Oncol 3:124–130PubMed

26.

Pikarsky AJ, Rosenthal R, Weiss EG et al (2002) Laparoscopic total mesorectal excision. Surg Endosc 16:558–562CrossRefPubMed

27.

Weeks JC, Nelson H, Gerber SL et al (2002) Short-term quality of life outcomes following laparascopic-assisted colectomy vs open colectomy. JAMA 287:321–328CrossRefPubMed

28.

Amato AC, Pescatori M (1998) Effect of perioperative blood transfusions on recurrence of colorectal cancer: meta-analysis stratified on risk factors. Dis Colon Rectum 41:570–585

29.

Soeters PB, de Zoete JP, de Jong CH (2002) Colorectal surgery and anastomotic leakage. Dig Surg 19:15–155

Title: Laparoscopic versus open total mesorectal excision: a case-control study
Authors: S. O. Breukink
J. P. E. N. Pierie
A. J. K. Grond
C. Hoff
T. Wiggers
W. J. H. J. Meijerink
Publication date: 01-09-2005
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 5/2005
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-004-0715-0

At a glance: The STEP trials

Springer Medicine

Laparoscopic versus open total mesorectal excision: a case-control study

Abstract

Background and aims

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background and aims

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2005

A case of pneumatosis cystoides intestinalis with dermatomyositis in which EUS was useful for the diagnosis

Transjugular intrahepatic porto-systemic shunt and variceal embolisation in the management of bleeding stomal varices

Gene expression profiles of different clinical stages of colorectal carcinoma: toward a molecular genetic understanding of tumor progression

Modified lay-open (incision, curettage, partial lateral wall excision and marsupialization) versus total excision with primary closure in the treatment of chronic sacrococcygeal pilonidal sinus

Sacral nerve stimulation for faecal incontinence following a rectosigmoid resection for colorectal cancer

Double frameshift mutations in APC and MSH2 in the same individual