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Laparoscopic surgery for rectal cancer feasible; may not be appropriate for routine use
In patients with mid- or low rectal cancer, laparoscopic surgery did not increase short-term oncological risks as predicted by circumferential resection margin positivity and macroscopic quality of total mesorectal excision compared with open surgery.
Researchers conducted the COREAN study to examine the safety and efficacy of laparoscopic surgery vs. open surgery. They assigned patients with mid- or low rectal cancer without distant metastasis after preoperative chemoradiotherapy to open surgery (n=170) or laparoscopic surgery (n=170).
The median blood loss was 217.5 mL in the open group vs. 200 mL in the laparoscopic group (P=.006). Surgery time, however, was longer for laparoscopy (244.9 minutes) than for open surgery (197 minutes; P<.0001).
There was no difference between groups for circumferential resection margin, macroscopic quality of the total mesorectal excision specimen, number of harvested lymph nodes and perioperative morbidity.
The median time to pass first flatus was 38.5 hours in the laparoscopic group vs. 60 hours in the open surgery group (P<.0001). Time to resume a normal diet was 85 hours with laparoscopy vs. 93 hours with open surgery (P<.0001), and median time to first defecation was also shorter with laparoscopy (96.5 hours) vs. open surgery (123 hours; P<.0001).
“The message to surgeons from the authors seems to be that achieving a high quality laparoscopic total mesorectal excision with adequate retraction, precise control of dissection plane and accurate division of rectum below the tumor is simply a matter of good patient selection, meticulous technique and experience,” Garret Nash, MD, and Philip B. Paty, MD, wrote in an accompanying editorial.
Nash is attending surgeon, in colorectal surgery service; Paty is vice chair of clinical research in the department of surgery, at Memorial Sloan-Kettering Cancer Center, in New York.
For more information:
- Kang SB. Lancet Oncol. 2010;doi:10.1016/S1470-2045(10)70131-5.