scholarly journals Conversion-to-open of laparoscopic surgery for rectal cancer: Impact on outcomes

2014 ◽  
Vol 61 (2) ◽  
pp. 31-33
Author(s):  
Evaghelos Xynos
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Low Anterior Resection ◽  
Survival Rates ◽  
Mortality Rates ◽  
Wound Infection Rate ◽  
Mesorectal Excision ◽  
Technical Limitation ◽  
Oncological Outcomes ◽  
Duration Of Surgery

Low anterior resection of the rectum (LARR) with total mesorectal excision (TME) for rectal cancer by laparoscopy is considered very technically demanding, particularly at the stages of dissection around the mesorectal fascia deep into the pelvis and transection of the rectum distally to the tumour. These technical difficulties translate to an increased conversion-to-open rate, higher than that seen after laparoscopic surgery for colon cancer. Conversion-to-open is considered as a technical limitation of the approach rather than a complication. There are reports claiming that converted cases are associated with higher morbidity rates than the laparoscopically completed. However, a review of the published articles indicates that conversion-to-open shows similar overall morbidity and mortality rates to those seen in the laparoscopically completed LARR-TME cases, and only duration of surgery is longer and wound infection rate is higher in the former group. Similarly, the overall oncological outcomes, namely local recurrence, distant metastasis and overall survival rates, are similar between the two groups.

scholarly journals Robotic Total Mesorectal Excision for Rectal Cancer: Short-Term Oncological Outcomes of Initial 178 Cases

2020 ◽  
Vol 11 (4) ◽  
pp. 653-661
Author(s):  
C. Ramachandra ◽  
Pavan Sugoor ◽  
Uday Karjol ◽  
Ravi Arjunan ◽  
Syed Altaf ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Minimally Invasive ◽  
Total Mesorectal Excision ◽  
Resection Margin ◽  
Da Vinci ◽  
Rectal Resection ◽  
Mesorectal Excision ◽  
Short Term ◽  
Oncological Outcomes ◽  
Duration Of Surgery

AbstractEmerging techniques in minimally invasive rectal resection include robotic total mesorectal excision (R-TME). The Da Vinci Surgical System offers precise dissection in narrow and deep confined spaces and is gaining increasing acceptance during recent times. The aim of this study is to analyse our initial experience of R-TME with Da Vinci Xi platform in terms of perioperative and oncological outcomes in the context of data from recently published randomised ROLARR trial amongst minimally invasive novice surgeons. Patients who underwent R-TME or tumour specific mesorectal excision for rectal cancer between May 2016 and November 2019 were identified from a prospectively maintained single institution colorectal database. Demographic, clinical-pathological and short-term oncological outcomes were analysed. Of the 178 patients, 117 (65.7%) and 31 (17.4%) patients had lower and mid third rectal cancer. Most of the tumours were locally advanced, cT3–T4: 138 (77.5%). One hundred/178 (56.2%) underwent sphincter preserving TME. Eighty-seven (48.8%) were grade II adenocarcinoma. Nonmucinous adenocarcinoma was the predominant histology, 138 (78.4%). One hundred one cases (56.7%) were pT3. The mean number of lymph node yield was 13 ± 5. Distal resection margin and circumferential resection margin were positive in 2 (1.12%), 12 cases (6.74%) respectively. Eleven cases (6.7%) had to be converted to open TME. Mean blood loss and duration of surgery was 170 ± 60 ml and 286 ± 45 min respectively. Five percent cases had an anastomotic leak. Grade IIIa–IIIb Clavien Dindo (CD) morbidity score was reported to be in 12 (6.75%) and 10 (5.61%) cases. Median length of hospitalisation was 7 days (range 4–14 days). Perioperative and pathologic outcomes following robotic rectal resection is associated with good short-term oncological outcomes and is safe, effective, and reproducible by a minimally invasive novice surgeon.

scholarly journals Comparison of the quality of total mesorectal excision after robotic and laparoscopic surgery for rectal cancer: a multicenter, propensity score-matched study

2021 ◽  
Vol 17 (2) ◽  
pp. 82-89
Author(s):  
Keehyun Park ◽  
Sohyun Kim ◽  
Hye Won Lee ◽  
Sung Uk Bae ◽  
Seong Kyu Baek ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Laparoscopic Surgery ◽  
Robotic Surgery ◽  
Survival Rates ◽  
Mesorectal Excision ◽  
Margin Involvement ◽  
Disease Free ◽  
Overall Survival Rates

Purpose: This study aimed to evaluate and compare the quality of total mesorectal excision (TME) and disease-free and overall survival rates between robotic and laparoscopic surgeries for rectal cancer.Methods: From January 2015 to December 2018, 234 patients underwent curative robotic or laparoscopic surgery for rectal cancer at two centers. Ultimately, 201 patients were enrolled. To control for different demographic factors in the two groups, propensity score matching was used at a 1:1 ratio. Propensity scores were generated with the baseline characteristics, including age, sex, body mass index, American Society of Anesthesiologists score, previous abdominal surgery, tumor location, preoperative chemotherapy, and preoperative radiation. Finally, 134 patients were matched with 67 patients in the robotic surgery group and 67 patients in the laparoscopic surgery group.Results: There was no significant difference in the pathologic stages between the robotic and laparoscopic surgery groups. Distal margin involvement was only observed in the robotic surgery group (1/67, 1.5%). Circumferential resection margin involvement was not different between the robotic surgery and laparoscopic surgery groups (3/67 [4.5%] and 4/67 [6.0%], respectively, P = 1.000). The quality of TME (complete, nearly complete, and incomplete) was similar between the robotic surgery and laparoscopic surgery groups (88.0%, 6.0%, 6.0% and 79.1%, 9.0%, 11.9%, respectively, P = 0.358). The disease-free and overall survival rates were not significantly different between the groups.Conclusion: The quality of TME and disease-free and overall survival rates between the two surgeries were similar. There was no oncologic advantage of robotic surgery for rectal cancer compared to laparoscopic surgery.

Prognosis Comparisons of Laparoscopy versus Open Surgery for Rectal Cancer Patients after Preoperative Chemoradiotherapy: A Meta-Analysis

2021 ◽  
Vol 44 (5) ◽  
pp. 261-268
Author(s):  
Jin-Wei Niu ◽  
Wu Ning ◽  
Zhi-Ze Liu ◽  
Dong-Po Pei ◽  
Fan-Qiang Meng ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Postoperative Complications ◽  
Open Surgery ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Current Evidence ◽  
Open Thoracotomy ◽  
Oncological Outcomes ◽  
Duration Of Surgery

<b><i>Aim:</i></b> We aimed to compare the oncological outcomes of laparoscopy and open resection for patients with rectal cancer following neoadjuvant chemoradiotherapy (NCRT). <b><i>Methods:</i></b> We searched the publications that compared the efficacy of laparoscopic surgery and open thoracotomy in treatment outcomes of rectal cancer after NCRT. All trials analyzed the summary hazard ratios of the endpoints of interest, including survival and individual postoperative complications. <b><i>Results:</i></b> Totally, 10 trials met our inclusion criteria. The pooled analysis of 3-year disease-free survival (OR 1.39, 95% CI 0.93–2.06; <i>p</i> = 0.11) and 3-year overall survival (OR 1.01, 95% CI 0.70–1.45; <i>p</i> = 0.97) showed that laparoscopic surgery did not achieve beneficial effects compared with open thoracotomy. The pooled result of duration of surgery indicated that laparoscopic surgery was associated with a trend for longer surgery time (SMD 27.53, 95% CI 1.34–53.72; <i>p</i> = 0.04), shorter hospital stay (SMD –1.64, 95% CI –2.70 to –0.58; <i>p</i> = 0.002), more postoperative complications (OR 0.77, 95% CI 0.60–0.99; <i>p</i> = 0.04), and decreased blood loss (SMD –49.87, 95% CI –80.61 to –19.14; <i>p</i> = 0.001). However, the number of removed lymph nodes, positive circumferential resection margin, as well as complications after surgery showed significant differences between the 2 groups. <b><i>Conclusions:</i></b> We focused on current evidence and reviewed the studies indicating that similar oncological outcomes were associated with laparoscopic surgery following NCRT for patients with locally advanced lower rectal cancer in comparison with open surgery.

OUTCOME OF SPHINCTER PRESERVING RECTAL RESECTION FOR LOW RECTAL CANCER

2017 ◽  
pp. 36-40
Author(s):  
Vinh Quy Truong ◽  
Anh Vu Pham ◽  
Quang Thuu Le
Keyword(s):  
Rectal Cancer ◽  
Functional Outcomes ◽  
Low Anterior Resection ◽  
Rectal Resection ◽  
Anal Verge ◽  
Low Rectal Cancer ◽  
Central Hospital ◽  
Mesorectal Excision ◽  
Pull Through ◽  
Stage T1

Purpose: To evaluate the functional outcome of sphincter-preserving rectal resection for low rectal cancer. Materials and Methods: From April 2009 to January 2016, there are 52 patients who underwent sphincter-preserving rectal resection with total mesorectal excision with low rectal cancer (<6cm from the anal verge) at Hue Central Hospital, Hue, Vietnam. Results: the average age 62.7 ± 12.8, the distance of tumor from anal verge include four group (≤ 3cm 1.9%; 3 to ≤ 4cm 17.3%; 4 to ≤ 5cm 34.6%; > 5 cm). T stage T1/ T2/T3: 1.9%/28.8%/69.2%. The following time is 33.8 ± 18.9 month. Overall recurrence was 13/18(27.1%), local recurrence was 5 (10.4%). Total survival was 40.5 ± 2.9 month. Technique: intersphincteric preservation 14 (26.9%), low anterior resection 17 (32.7%) and pull-through procedure 21 (40.4%). The distance of anatomosis from anal verge: from 1 to ≤ 2 cm:14 (26.9%); from 2 to ≤ 3cm: 21 (40.4%); from 3 to ≤ 4 cm: 17 (32.7%). Bowels movement of 3 month: 4.7 ± 3.2 and 12th month: 2.7 ± 1.6 (p< 0.01). Conclusions: Sphincterpreserving rectal resection using may provide a good continence and oncologic safety. The patients are acceptable with the results of functional outcomes. Key words: Low rectal cancer, sphincter-preserving

Neorectum prolapse after rectal cancer surgery corrected with perineal stapled prolapse resection

2022 ◽  
Vol 15 (1) ◽  
pp. e246356
Author(s):  
Joanna Pauline A Baltazar ◽  
Marc Paul J Lopez ◽  
Mark Augustine S Onglao
Keyword(s):  
Rectal Cancer ◽  
Rectal Prolapse ◽  
Low Anterior Resection ◽  
Coloanal Anastomosis ◽  
Intersphincteric Resection ◽  
Rectal Cancer Surgery ◽  
Anal Pain ◽  
Full Thickness ◽  
Mesorectal Excision ◽  
Perineal Stapled Prolapse Resection

A 61-year-old woman developed neorectal prolapse after laparoscopic low anterior resection, total mesorectal excision with partial intersphincteric resection and handsewn coloanal anastomosis for rectal cancer. She presented with a 3 cm full thickness reducible prolapse, with associated anal pain and bleeding. A perineal stapled prolapse resection was performed to address the rectal prolapse, with satisfactory results.

Sign in / Sign up

Export Citation Format

Share Document