Laparoscopic vs. open total mesorectal excision for treatment of rectal cancer.
BACKGROUND
Because definitive long-term results are not yet available, the oncologic safety of laparoscopic surgery in rectal cancer remains controversial. Laparoscopic total mesorectal excision (LTME) for rectal cancer has been proposed to have several short-term advantages in comparison with open total mesorectal excision (OTME). However, few prospective randomized studies have been performed.


OBJECTIVE
The main purpose was to evaluate whether there are relevant differences in safety and efficacy after elective LTME for the treatment of rectal cancer compared with OTME in a tertiary academic medical center.


METHODS
This comparative non-randomized prospective study analyzes data of 20 patients with middle and low rectal cancer treated with low anterior resection (LAR) or abdomino perineal resection (APR) from November 2005 to April 2006. Follow-up was determined through office charts or direct patient contact. Statistical analysis was performed using chi2 test and Student's t-test.


RESULTS
Ten patients underwent LTME and 10 patients underwent OTME. No conversion was required in the LTME group. Mean operating time was shorter in the laparoscopic group (LTME) (186.7 vs. 204.4 min, p < 0.007). Less intraoperative blood loss and fewer postoperative complications were seen in the LTME group. An earlier return of bowel motility was achieved after laparoscopic surgery. There was no 30-day mortality and the overall morbidity was 20% in the LTME group vs. 40% in the OTME group. The mean number of harvested lymph nodes was greater in the laparoscopic group than in OTME group (10.2 +/- 2.5 vs. 8.3 +/- 3). Mean follow-up time was 12 months (range 9-15 months). No local recurrence was found.


CONCLUSIONS
LTME is a feasible procedure with acceptable postoperative morbidity and low mortality, however it is technically demanding. This series confirms its safety, while oncologic results are at present comparable to the OTME published series, with limitation of a short follow-up period though. Further randomized studies are necessary to evaluate long-term clinical outcome.
González
Quintín H
QH
Departamento de Cirugía, Servicio de Colon y Recto Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, D.F. quinhec@hotmail.com
Rodríguez-Zentner
Homero A
HA
Moreno-Berber
J Manuel
JM
Vergara-Fernández
Omar
O
de León
Héctor Tapia-Cid
HT
López-R
Federico
F
Jonguitud
Luis A
LA
Ramos
Roberto
R
Castañeda-Argáiz
Roberto
R
D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*