Our experience at Bangabandhu Sheikh Mujib Medical University on laparoscopic assisted surgery for rectal cancer
DOI:
https://doi.org/10.18203/2349-2902.isj20243537Keywords:
Colorectal cancer, Laparoscopic surgery, Rectal cancerAbstract
Background: Rectal cancer is a leading cause of mortality worldwide, with laparoscopic surgery emerging as a viable alternative to open surgery due to its benefits in postoperative recovery, pain management and survival rates. Despite its advantages, laparoscopic colorectal resection faces scrutiny over oncologic safety and technical demands, limiting its widespread adoption.
Methods: This retrospective descriptive study analyzed 60 patients with colorectal adenocarcinoma treated at the Department of Colorectal Surgery, BSMMU, from January 2018 to December 2018. Inclusion criteria encompassed clinically diagnosed colorectal cancer with histological confirmation. Data on demographics, tumor characteristics, surgical details and postoperative outcomes were collected and analyzed with SPSS software.
Results: Among the 60 patients, 32 were male, with a mean age of 52 years. Tumors within 5 cm of the anal verge necessitated abdominoperineal resections (n=44), while anterior resections were performed for the remaining (n=16). All patients achieved adequate proximal margins (>5 cm) and most (90%) had distal margins >2 cm. The average operative time ranged from 190 to 270 minutes, with no intraoperative complications and a postoperative stay of 3-5 days. Patients reported less postoperative pain and faster recovery.
Conclusions: Laparoscopic colorectal surgery demonstrated similar oncologic outcomes to open surgery but involved a longer operative time and required advanced surgical skills. The benefits included reduced blood loss, lower postoperative pain and a shorter hospital stay, although costs were higher. A need for expert surgeons in selected patients is emphasized for optimal outcomes. Laparoscopic resection for rectal cancer aligns with oncologic principles and offers a safe, effective approach, yielding improved recovery metrics compared to traditional surgery. Further analysis on cost-effectiveness, especially for lower socioeconomic populations, is warranted to enhance accessibility.
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References
Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc. 1991;1(3):144-50.
Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery: the clue to pelvic recurrence? Br J Surg. 1982;69(10):613-6.
Akle CA. Early parietal recurrence of adenocarcinoma of the colon after laparoscopic colectomy. Port site metastasis after laparoscopic colorectal surgery for cure of malignancy. Br J Surg. 1996;83(3):427.
Taffinder NJ, Champault G. Port site metastases after laparoscopic colorectal surgery for cure of malignancy. Br J Surg. 1996;83(1):133.
Campos FG, Valarini R. Evolution of laparoscopic colorectal surgery in Brazil: results of 4744 patients from the national registry. Surg Laparosc Endosc Percutan Tech. 2009;19(3):249-54.
Rosen M, Ponsky J. Minimally Invasive Surgery. Endoscopy. 2001;33(4):358-66.
Guillou PJ, Quirke P, Thorpe H. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MCR CLASICC trial): multicentre, randomized controlled trial. Lancet. 2005;365(9472):1718-26.
Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg. 1998;133(8):894-9.
García-Aguilar J, Smith DD, Avila K. Impact of tumor stage on outcomes of laparoscopic colorectal surgery. Ann Surg Oncol. 2015;22(3):856-62.
DeNardi P, Cassini D, Sammartino M. Laparoscopic colorectal resection and oncological safety: A retrospective analysis. Surg Oncol. 2019;28(1):45-50.
Miskovic D, Nicholls RJ. Conversion rates in laparoscopic colorectal surgery: A review of the literature. Colorectal Dis. 2019;21(1):1-6.
Cao C, D’Amico T, Demmy T. Laparoscopic approaches and postoperative outcomes: A meta-analysis. J Minim Invasive Surg. 2018;26(2):152-60.
Nguyen NT, Goldman C, Rosenquist C. Hospital stay and recovery times following laparoscopic vs open colorectal surgery. J Gastrointest Surg. 2017;21(10):1483-90.
Cao Q, Jiang T, Zhang S. Laparoscopic surgery for colorectal cancer: a meta-analysis of short-term outcomes. J Laparoendosc Adv Surg Tech A. 2011;21(10):1013-21.
Ramsay G, Piper J, LeBlanc J. Comparing recovery times after anterior resection and abdominoperineal resection in colorectal cancer surgery. Colorectal Cancer Rep. 2020;15(3):275-82.
Ong J, Lee S, Wong W. Learning curve in laparoscopic colorectal surgery: Overcoming the technical challenges. Surg Endosc. 2021;35(4):1957-64.
Rosen M, Ponsky J. Minimally Invasive Surgery. Endoscopy. 2001;33(4):358-66.