Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic-assisted approach in rectal cancer patients: lessons learned from >200 patients

  • Original article
  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background

The applicability of laparoscopic surgery in the treatment of colorectal diseases is still controversial. Early reports on laparoscopic-assisted colectomy in patients with colon cancer suggested that it minimizes surgical trauma, decreases perioperative complications, and leads to a more rapid recovery. To our knowledge, no previous studies have compared the laparoscopic vs the open approach in rectal cancer. The aim of this paper was to assess the results of laparoscopic techniques in patients with rectal cancer.

Methods

From March 1998 to February 2003, all patients admitted to our unit with adenocarcinoma of the rectum were evaluated for surgery by the laparoscopic approach.

Results

A total of 220 patients with a mean age of 67.3 years were included in the study. One hundred thirty patients (59%) were treated with neoadjuvant chemoradiotherapy. In >75% of the patients, a surgical procedure with sphincter preservation was perfomed. The rate of conversion to the open approach was 20%. Ten patients had intraoperative complications. Fifty-eight patients (26.3%) developed postoperative complications. The length of hospital stay was 6.8 days. The distribution of tumor stages was as follows: stage I, 16.81%; stage II, 33.6%; stage III, 26.36%; stage IV, 19.09%. The mean number of lymph nodes was 13.8. The incidence of local relapse was 5.3%, with a follow-up of 18 months.

Conclusion

Laparoscopic surgery can be safely performed in patients with adenocarcinoma of the rectum with good short-term results. Randomized controlled trials are needed to confirm these results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. RP Baker EE White L Titu GS Duthie PW Lee JR Monson (2002) ArticleTitleDoes laparoscopic abdominoperineal resection of the rectum compromise long-term survival? Dis Colon Rectum 45 1481–1485 Occurrence Handle12432295

    PubMed  Google Scholar 

  2. E Carlsen E Schlichting I Guldvogl E Johnson RJ Heald (1998) ArticleTitleEffect of the introduction of total mesorectal excision for the treatment of rectal cancer Br J Surg 85 526–529 Occurrence Handle10.1046/j.1365-2168.1998.00601.x Occurrence Handle1:STN:280:DyaK1c3mvVGmtA%3D%3D Occurrence Handle9607540

    Article  CAS  PubMed  Google Scholar 

  3. S Delgado AM Lacy X Filella A Castells JC Garcia Valdecasas JM Piqué D Momblán J Visa (2001) ArticleTitleAcute phase response in laparoscopic and open colectomy in colon cancer: randomized study Dis Colon Rectum 44 638–646 Occurrence Handle1:STN:280:DC%2BD3M3msVeiug%3D%3D Occurrence Handle11357021

    CAS  PubMed  Google Scholar 

  4. Fleming, ID, Cooper, JS, Henson, DE, Hutter, RVP, Kennedy, BJ, Murphy, GP, O’Sullivan, B, Sobin, LH, Yarbo, JW (eds.) (1997) “American Joint Committee of Cancer: cancer staging manual Colon and Rectum”, Lippincott Williams & Wilkins, Philadelphia

  5. MEJ Franklin D Rosenthal D Abrego-Medina JP Dorman JL Glass R Norem A Diaz (1996) ArticleTitleProspective comparison of open vs. laparoscopic colon surgery for carcinoma: five year results Dis Colon Rectum 39: S35–S46

    Google Scholar 

  6. ME Franklin GB Kazantsev D Abrego JA Diaz-E J Balli JL Glass (2000) ArticleTitleLaparoscopic surgery for stage III colon cancer: long-term follow-up Surg Endosc 14 612–616 Occurrence Handle10.1007/s004640000169 Occurrence Handle1:STN:280:DC%2BD3M7gvFWmsw%3D%3D Occurrence Handle10948295

    Article  CAS  PubMed  Google Scholar 

  7. JE Hartley BJ Mehigan AE Qureshi GS Duthie PWR Lee JRT Monson (2001) ArticleTitleTotal mesorectal excision: assessment of the laparoscopic approach Dis Colon Rectum 44 315–321 Occurrence Handle1:STN:280:DC%2BD3M7pvFyktw%3D%3D Occurrence Handle11289275

    CAS  PubMed  Google Scholar 

  8. RJ Heald RD Ryall (1986) ArticleTitleRecurrence and survival after total mesorectal excision for rectal cancer Lancet 1 1479–1482 Occurrence Handle10.1016/S0140-6736(86)91510-2 Occurrence Handle1:STN:280:BimB2Mros1w%3D Occurrence Handle2425199

    Article  CAS  PubMed  Google Scholar 

  9. RJ Heald BJ Moran RD Ryall R Sexton JK MacFarlane (1998) ArticleTitleRectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997 Arch Surg 133 894–899 Occurrence Handle10.1001/archsurg.133.8.894 Occurrence Handle1:STN:280:DyaK1cznsFOrsQ%3D%3D Occurrence Handle9711965

    Article  CAS  PubMed  Google Scholar 

  10. W Hohenberger CH Schick J Gohl (1998) ArticleTitleMesorectal lymph node dissection: is it beneficial? Langenbecks Arch Surg 383 402–408 Occurrence Handle10.1007/s004230050152 Occurrence Handle1:STN:280:DyaK1M7hvV2isA%3D%3D Occurrence Handle9921939

    Article  CAS  PubMed  Google Scholar 

  11. E Kapiteijn CA Marijnen AC Colenbrander E Klein Kranenbarg WH Steup JH Krieken Particlevan JC Houwelngen Particlevan et al. (1998) ArticleTitleLocal recurrence in patients with rectal cancer diagnosed between 1988 and 1992: a population-based study in the Netherlands Eur J Surg Oncol 24 528–535 Occurrence Handle1:STN:280:DyaK1M%2Fos1aktA%3D%3D Occurrence Handle9870729

    CAS  PubMed  Google Scholar 

  12. AM Lacy JC García Valdecasas S Delgado A Castells P Taurà JM Piqué J Visa (2002) ArticleTitleRandomized trial of laparoscopic-assisted colectomy versus open colectomy for the treatment of non-metastatic colon cancer Lancet 359 2224–2229 Occurrence Handle10.1016/S0140-6736(02)09290-5 Occurrence Handle12103285

    Article  PubMed  Google Scholar 

  13. E Lezoche F Feliciotti AM Paganini M Guerrieri A Sanctis ParticleDe R Campagnacci G D’Ambrosio (2002) ArticleTitleResults of laparoscopic versus open resections for non–early rectal cancer in patients with a minimum follow-up of four years Hepatogastroenterology 49 1185–1190 Occurrence Handle12239902

    PubMed  Google Scholar 

  14. F Lopez-Kostner IC Lavery GR Hool LA Rybichi VW Fazio (1998) ArticleTitleTotal mesorectal excision is not necessary for cancers of the upper rectum Surgery 124 612–617 Occurrence Handle10.1067/msy.1998.91361 Occurrence Handle1:STN:280:DyaK1cvlsValtg%3D%3D Occurrence Handle9780979

    Article  CAS  PubMed  Google Scholar 

  15. HJ Lujan G Plasencia M Jacobs M Viamonte RF Hartmann (2002) ArticleTitleLong-term survival after laparoscopic colon resection for cancer: complete five-year follow-up Dis Colon Rectum 45 491–501 Occurrence Handle12006931

    PubMed  Google Scholar 

  16. M Morino U Parini G Giraudo M Salval R Brachet Contul C Garrone (2003) ArticleTitleLaparoscopic total mesorectal excision: a consecutive series of 100 patients Ann Surg 237 335–342 Occurrence Handle10.1097/00000658-200303000-00006 Occurrence Handle12616116

    Article  PubMed  Google Scholar 

  17. SJ Neuhaus M Texler PJ Hewett DI Watson (1998) ArticleTitlePort-site metastases following laparoscopic surgery Br J Surg 85 735–741 Occurrence Handle10.1046/j.1365-2168.1998.00769.x Occurrence Handle1:STN:280:DyaK1czjtVaksw%3D%3D Occurrence Handle9667697

    Article  CAS  PubMed  Google Scholar 

  18. AJ Pikarsky R Rosenthal EG Weis SD Wexner (2002) ArticleTitleLaparoscopic total mesorectal excision Surg Endosc 16 558–562 Occurrence Handle10.1007/s00464-001-8250-3 Occurrence Handle1:STN:280:DC%2BD383jsVeksA%3D%3D Occurrence Handle11972187

    Article  CAS  PubMed  Google Scholar 

  19. EC Poulin J Mamazza CM Schlachta R Gregoire N Roy (1999) ArticleTitleLaparoscopic resection does not adversely affect early survival curves in patients undergoing surgery for CRC Ann Surg 229 487–492 Occurrence Handle10.1097/00000658-199904000-00006 Occurrence Handle1:STN:280:DyaK1M3hslOgsg%3D%3D Occurrence Handle10203080

    Article  CAS  PubMed  Google Scholar 

  20. EC Poulin CM Schlachta R Grégoire P Seshadri MO Cadeddu J Mamazza (2002) ArticleTitleLocal recurrence and survival after laparoscopic mesorectal resection for rectal adenocarcinoma Sur Endosc 16 989–995 Occurrence Handle10.1007/s004640080182 Occurrence Handle1:STN:280:DC%2BD38vgvFGlsw%3D%3D

    Article  CAS  Google Scholar 

  21. H Scheidbach C Schneider O Huegel E Barlehner J Konradt C Wittekind F Kockerling (2002) ArticleTitleLaparoscopic sigmoid resection for cancer: curative resection and preliminary medium-term results Dis Colon Rectum 45 1641–1647 Occurrence Handle1:STN:280:DC%2BD38jjtF2jtQ%3D%3D Occurrence Handle12473888

    CAS  PubMed  Google Scholar 

  22. T Schiedeck O Schwandner I Baca E Baehrlehner J Konradt F Kockerking A Kuthe et al. (2000) ArticleTitleLaparoscopic surgery for the cure of colorectal cancer: results of a German five-center study Dis Colon Rectum 43 1–8 Occurrence Handle1:STN:280:DC%2BD3c3ntFahtg%3D%3D Occurrence Handle10813116

    CAS  PubMed  Google Scholar 

  23. M Simunovic R Sexton E Rempel BJ Moran RJ Heald (2003) ArticleTitleOptimal preoperative assessment and surgery for rectal cancer may greatly limit the need for radiotherapy Br J Surg 90 999–1003 Occurrence Handle10.1002/bjs.4210 Occurrence Handle1:STN:280:DC%2BD3szntVSksw%3D%3D Occurrence Handle12905555

    Article  CAS  PubMed  Google Scholar 

  24. S Vithiananthan Z Cooper K Betten GS Stapleton J Carter EH Huang RL Whelan (2001) ArticleTitleHybrid laparoscopic flexure takedown and open procedure for rectal resection is associated with significantly shorter length of stay than equivalent open resection Dis Colon Rectum 44 927–935 Occurrence Handle1:STN:280:DC%2BD3MvkvFSisA%3D%3D Occurrence Handle11496070

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Institute of Digestive Diseases, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain

    S. Delgado, D. Momblán, L. Salvador, R. Bravo, A. Ibarzabal & A. M. Lacy

  2. Department of Gastroenterology, Institute of Digestive Diseases, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain

    A. Castells & J. M. Piqué

Authors
  1. S. Delgado
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Momblán
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Salvador
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Bravo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Castells
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Ibarzabal
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. M. Piqué
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. M. Lacy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. M. Lacy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Delgado, S., Momblán, D., Salvador, L. et al. Laparoscopic-assisted approach in rectal cancer patients: lessons learned from >200 patients. Surg Endosc 18, 1457–1462 (2004). https://doi.org/10.1007/s00464-003-8831-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-003-8831-4

Keywords

Search

Navigation