Laparoscopic Versus Open Total Mesorectal Excision : A Nonrandomized Comparative Prospective Trial in a Tertiary Center in Mexico City

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 mesor...

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Bibliographic Details
Published in:The American surgeon 2009, Vol.75 (1), p.33-38
Main Authors: GONZALEZ, Quintin H, RODRIGUEZ-ZENTNER, Homero A, MORENO-BERBER, J. Manuel, VERGARA-FERNANDEZ, Omar, TAPIA-CID DE LEON, Héctor, JONGUITUD, Luis A, RAMOS, Roberto, MORENO-LOPEZ, J. Andrés
Format: Article
Language:English
Subjects:
Adenocarcinoma - pathology
Adenocarcinoma - surgery
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Colorectal cancer
Digestive System Surgical Procedures - adverse effects
Digestive System Surgical Procedures - methods
Digestive system. Abdomen
Endoscopy
Female
Follow-Up Studies
General aspects
Hospitals
Humans
Investigative techniques, diagnostic techniques (general aspects)
Laparoscopy
Male
Medical sciences
Mexico
Middle Aged
Mortality
Ostomy
Prospective Studies
Rectal Neoplasms - pathology
Rectal Neoplasms - surgery
Treatment Outcome
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Summary: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. The main purpose of our study was to evaluate whether relevant differences in safety and efficacy exist after elective LTME for the treatment of rectal cancer compared with OTME in a tertiary referral medical center. This comparative nonrandomized prospective study analyzes data in 56 patients with middle and lower rectal cancer treated with low anterior resection or abdominoperineal resection from November 2005 to November 2007. Follow-up was determined through office charts or direct patient contact. Statistical analysis was performed using chi2 test and Student's t test. Twenty-eight patients underwent LTME and 28 patients were in the OTME group. No conversion was required in the LTME group. Mean operating time was shorter in the laparoscopic group (LTME) (181.3 vs 206.1 min, P < 0.002). Less intraoperative blood loss and fewer postoperative complications were seen in the LTME group. Return of bowel motility was observed earlier after laparoscopic surgery. There was no 30-day mortality and the overall morbidity was 17 per cent in the LTME group versus 32 per cent in the OTME group. The mean number of harvested lymph nodes was greater in the laparoscopic group than in the OTME group (12.1 +/- 2 vs 9.3 +/- 3). Mean follow-up time was 12 months (range 9-24 months). No local recurrence was found. LTME is a feasible procedure with acceptable postoperative morbidity and low mortality, however it is technically demanding. This series confirms its safety, although oncologic results are at present comparable with the OTME published series with the limitation of a short followup period. Further randomized studies are necessary to evaluate long-term clinical outcome.
ISSN:0003-1348
1555-9823
DOI:10.1177/000313480907500107