Minimal access oncology surgery

Apollo Medicine 2012 JuneVolume 9, Number 2; pp. 158e159 Journal Scan

Minimal access oncology surgery

Arun Prasad

Robotic and laparoscopic total mesorectal excision for rectal cancer: a case-matched study. Jeong-HeumBaek, Carlos Pastor, Alessio Pigazzi. Surg Endosc. 2011;25(2):521e525, doi:10.1007/s00464-010-1204-x, Published inpartnership with SAGES and EAES.

Abstract:

Background: Robotic total mesorectal excision (RTME), a novel approach for the treatment of rectal cancer, has beenshown in previous studies to be safe and effective. However, the results of this approach compared with laparoscopic totalmesorectal excision (LTME) have not been reported in terms of clinical outcome and oncologic data. This study comparedearly outcomes for rectal cancer between two groups.Methods: Between April 2003 and March 2009, 82 patients from a prospectively maintained database were enrolled ina case-matched study. The patients were matched for gender, age, body mass index (BMI), and type of operative procedure.Results: Neoadjuvant chemoradiotherapy was performed for 33 RTME patients (80.5%) and 18 LTME patients (43.9%)(p¼ 0.001). The mean operative time was 296 min for RTME and 315 min for LTME (p¼ 0.357). The number of conversionswas 3 (7.3%) for RTME and 9 (22%) for LTME (p¼ 0.12). The anastomotic leak rate after surgery did not differ betweenRTME (n¼ 3, 8.6%) and LTME (n¼ 1, 2.9%) (p¼ 0.62). The mean number of harvested lymph nodes was 13.1 withRTME and 16.2 with LTME (p¼ 0.07), and negative distal resection margins (DRMs) were noted in all surgical specimens.Positive circumferential resections (CRMs) were identified in 2.4% of the RTME cases and 4.9% of the LTME cases. Nodifference was noted in lengths of the DRMs, times until a liquid diet, or postoperative hospital stays. The total hospitalizationcosts were higher in the RTME group, although the difference did not reach statistical significance. There was no operativemortality or port-site recurrence in either group.Conclusion: For rectal cancer, RTME may be as feasible and safe as LTME in terms of technical and oncologic issues.Further prospective randomized trials are necessary for conclusions to be drawn concerning definite oncologic outcomesof robotic procedures for rectal cancer.

Senior Consultant Surgeon, Minimal Access, GI, Thoracoscopic & Bariatric Surgery, Apollo Hospital, New Delhi, India.Available online: 11.5.2012doi:10.1016/j.apme.2012.05.007

Survival following laparoscopic versus open resection for colorectal cancer. Wai Lun Law, Jensen TC Poon, Joe KMFan, Oswens SH Lo. Int J Colorectal Dis. 2012. doi:10.1007/s00384-012-1424-8. http://www.springer.com/openaccess/

Abstract:

Background: This study aimed to compare the overall and disease specific survivals of patients who underwent laparo-scopic and open resection of colorectal cancer in a high volume tertiary center.Methods: Consecutive patients who underwent elective resection for colorectal cancer (open resection, n¼ 1197; laparo-scopic resection, n¼ 814) from January 2000 to December 2009 were included. The operative details, postoperative compli-cations, postoperative outcomes, and survival data were collected prospectively. Comparison was made between patientswho had laparoscopic and open surgery.Results: The age, gender, medical morbidity, and American Society of Anesthesiologists status were similar in the twogroups. Laparoscopic resection was associated with significantly less blood loss and a shorter hospital stay. The operatingmortality and morbidity were significantly lower in the laparoscopic group. The qualities of the specimens in terms of thedistal resection margin and the number of lymph nodes examined were not inferior in the laparoscopic group. With themedian follow-up of 40.3 months, the 5-year overall survival (74.1% vs. 65.5%, p< 0.001) and disease specific survival(81.9% vs. 75.2%, p¼ 0.002) were significantly better in patients with non-disseminated disease in the laparoscopic group.The operative approach was an independent prognostic factor in the overall (risk ratio 1.36, 95% CI 1.093e1.700, p¼ 0.006)and disease specific (risk ratio 1.32, 95% CI 1.005e1.738, p¼ 0.048) survivals in multivariate analysis.Conclusion: Laparoscopic resection for colorectal cancer is associated with more favorable overall and disease specificsurvivals when compared with open resection in a high volume tertiary center.

Minimal access oncology surgery Journal Scan 159

COMMENT

For the last three decades, there has been significant interest in understanding and defining the role of minimally invasive surgeryin colorectal cancer. Laparoscopic surgery has been shown to have similar or better outcomes compared with open surgery.Recently, prospective randomized trials have demonstrated oncologic outcomes of laparoscopic colon surgery equivalent tothose for open surgery. However, the technical challenges of performing laparoscopic resection of rectal cancers and the uncer-tainty of the oncologic quality of the surgical resection have hindered the growth of minimally invasive rectal surgery.

Robotic rectal surgery has recently emerged as an attractive alternative to laparoscopic surgery because it allows for superiorvisualization within a narrow pelvic field and more precise dissection. Studies of robotic rectal resection have suggested similar orpotentially improved short-term oncologic outcomes when compared with laparoscopic rectal resection.

Ongoing randomized studies will provide additional insight into the role of laparoscopic and minimally invasive robotic surgeryfor rectal cancer.

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