Trastulli S, Cirocchi R, Listorti C, et al. Laparoscopic versus open resection for rectal cancer: a meta-analysis of randomized clinical trials

Department of General Surgery, S Maria Hospital, University of Perugia, Terni, Italy.
Colorectal Disease (Impact Factor: 2.35). 02/2012; 14(6):e277-96. DOI: 10.1111/j.1463-1318.2012.02985.x
Source: PubMed


Laparoscopic and open rectal resection for cancer were compared by analysing a total of 26 end points which included intraoperative and postoperative recovery, short-term morbidity and mortality, late morbidity and long-term oncological outcomes.
We searched for published randomized clinical trials, presenting a comparison between laparoscopic and open rectal resection for cancer using the following electronic databases: PubMed, OVID, Medline, Cochrane Database of Systematic Reviews, EBM Reviews, CINAHL and EMBASE.
Nine randomized clinical trials (RCTs) were included in the meta-analysis incorporating a total of 1544 patients, having laparoscopic (N = 841) and open rectal resection (N = 703) for cancer. Laparoscopic surgery for rectal cancer was associated with a statistically significant reduction in intraoperative blood loss and in the number of blood transfusions, earlier resuming solid diet, return of bowel function and a shorter duration of hospital stay. We also found a significant advantage for laparoscopy in the reduction of post-operative abdominal bleeding, late intestinal adhesion obstruction and late morbidity. No differences were found in terms of intra-operative and late oncological outcomes.
The meta-analysis indicates that laparoscopy benefits patients with shorter hospital stay, earlier return of bowel function, reduced blood loss and number of blood transfusions and lower rates of abdominal postoperative bleeding, late intestinal adhesion obstruction and other late morbidities.

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Available from: Nicola Avenia, Oct 11, 2014
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    • "The results from different studies and randomized trials have demonstrated the safety and reliability of laparoscopy and oncological advantages over open surgery in terms of operative parameters and a quicker resumption of daily activities [3]. * Corresponding author. "
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    ABSTRACT: Aim: Robotic systems are getting widely spread in recent years given the different technical advantages over traditional laparoscopy. Rectal surgery seems to benefit from this approach, for its ability to easily work in a confined space such as the pelvic cavity. The objective is to present results obtained by the robotic approach in patients with rectal cancer and to give technical considerations. Method: Data were prospectively collected in order to evaluate surgical and oncological outcomes. Subjects underwent robotic rectal resection in the period between June 2011 and June 2014 at the Department of Digestive Surgery, "S. Maria" Hospital - Terni (Italy). Main outcome measures: Patient characteristics and tumor, overall operative time, conversion to open surgery, site of mini-laparotomy for specimen extraction, intraoperative blood loss, intraoperative complications, time to first bowel movement, time-to-liquid and solid intake, postoperative complications, mortality, hospital stay, thirty-day complications, histopathological examination. Results: 40 consecutive patients underwent robotic resection of the rectum. Median operative time was 340 min (235-460 min), no procedure was converted. Median hospital stay was 5 days (3-18 days). Mesorectum resection was complete in all patients. Median number of harvested lymph nodes was 19 (6-35), median distal resection margin was 4 cm (2-8 cm). Conclusion: Robotic rectal surgery is safe and feasible in particular by facilitating the surgeon during the delicate phases of tissue dissection. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
    Full-text · Article · Nov 2014 · International Journal of Surgery (London, England)
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    • "The introduction of TME [4, 5], first described by Heald et al. in 1982 [6], was a milestone in the treatment of rectal cancer [7]. Many studies, however, have shown that TME is a technically demanding procedure that requires excision of the intact mesorectum, in the narrow space of the pelvic cavity [3, 8–10]. "
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    ABSTRACT: Laparoscopy-assisted low anterior resection (LAR) of colorectal cancer, using a posterior surgical approach, is a difficult and controversial procedure to perform. We report successful operations on 13 patients with clear surgical margins and no serious complications. Thirteen patients [10 males and three females, age range: 48 to 69 years (median: 61 years)] with low adenocarcinoma confirmed by preoperative colonoscopic biopsy (four stage T1; nine stage T2) were resected. The distance from inferior edge of tumor to dentate line was 2 ~ 5 cm (average: 3.4 cm). Intraperitoneal laparoscopy was performed to isolate rectosigmoid and mesocolon moving toward distal end of the tumor. Perineal operation was performed in the prone clasp-knife position. The circumferential resection margin (CRM) was negative in all cases. No serious postoperative complications occurred. There were four cases of perineal wound infection, two cases with superficial perineal wound dehiscence, and two cases with persistent postoperative sacral pain. All 13 patients passed the Wexner continence test and had satisfactory anal function during a mean 18-month postoperative follow-up period. Laparoscopic posterior LAR of colorectal cancer is a safe and reliable treatment for patients with low colorectal cancer, increasing the chance of anal functional recovery. Trial registration Chinese Clinical Trial Register ChiCTR-ONC-14005145. Registered 19 August 2014.
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    • "Multiple factors dictating postoperative course and outcome in colorectal cancer have been identified including markers of the extent of systemic inflammatory response such as the Glasgow Prognostic Score (GPS), C-reactive protein, and albumin [13] [14] [15]. In addition, physiological parameters [16], patient comorbidity [17], and operative strategy [18] [19] have been shown to influence postoperative course and outcome. In contrast, limited information regarding the factors associated with increased delay to commencement of adjuvant therapy is available; however, age and race have been "
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    ABSTRACT: Purpose: Timely administration of adjuvant chemotherapy following colorectal resection is associated with improved outcome. We aim to assess the factors which are associated with delay to adjuvant chemotherapy in patients who underwent colorectal resection as part of an enhanced recovery protocol. Method: A univariate and multivariate analysis of patient data collected as part of a prospectively maintained database of colorectal cancer patients between 2007 and 2012. Results: 166 patients underwent colorectal resection followed by adjuvant chemotherapy. Median postoperative hospital stay was 6 days, and time to commencement of adjuvant chemotherapy was 50 days. Longer inpatient stay correlated with increased time to adjuvant chemotherapy (P = 0.05). Factors found to be independently associated with duration of hospital stay and time to commencement of adjuvant chemotherapy included stoma formation (P = 0.032), anastaomotic leak (P = 0.027), and preoperative albumin (P = 0.027). The use of laparoscopic surgery was associated with shorter time to adjuvant chemotherapy but did not reach significance (P = 0.143). Conclusion: A number of independent variables associated with delay to adjuvant therapy previously not described have been identified. Further work may be required to elucidate the effect that these variables have on long-term outcome.
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