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LAPAROSCOPIC HYBRID RECTAL RESECTION FOR RECTAL CANCER
Author(s) -
Shedda S. M.,
Hayes I.,
Jones I. T.,
Hastie I.,
Gibbs P.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04915_26.x
Subject(s) - medicine , colorectal cancer , dissection (medical) , surgery , stage (stratigraphy) , laparoscopy , lymph node , cancer , prospective cohort study , gastroenterology , paleontology , biology
Laparoscopic anterior resection for rectal cancer remains controversial due to the possibility of a positive circumferential margin with the laparoscopic approach. The “hybrid procedure” has been performed with laparoscopic colonic mobilization but rectal dissection is through a Pfannenstiel incision. Methods: Data from a prospective single institution rectal cancer database was used to compare hybrid, converted and open anterior resections for mid and low rectal cancer from February 2003 to August 2008. Results: There were 253 patients found. There were 66 (26%) hybrid (H), 5 (2%) converted (C) and 182 (72%) open (O) cases. The median follow up all 3 groups was similar. 30 (h), 28 (C), 34 (O) months. The median length of stay (days) was shorter in the (H) group. [6.5 (H), 10 (C), 9 (O), p = 0.001. There was a trend to a higher ASA score, age, median BMI, more wound infections and higher stage in the (O) group. The circumferential margin was involved in 6 (O) group compared with 0 in H) or (C) group (p = 0.5). There were no significant differences in local recurrences [1.1% (O) vs. 1.5% (H&C)] or T stage. There was no difference in neoadjuvant radiation, (48 (26%) (O), 20 (30%) (H), 1 (20%), p = 0.9. The median lymph node count was 11 in each group. The 2 year overall survival was the same both groups, 90% (H), 89% (O) 100% (C) (p = 0.65) as was the progression free survival 76% (H), 64%(O), 80% (C), (p = 0.32). Conclusion: The hybrid procedure results in improved short term outcomes for patients with rectal cancer compared to open cases. The hybrid approach did not compromise circumferential margins or lymph node yield, and has no effect in short term progression free or overall survival.