Rectal cancer within 10 cm.Comparison of the radicality of laparoscopic and open surgical techniques with regard to the circumferential resection margin and the completeness of mesorectal excision
Abstract
The issue of achieving radical circumferential margin in laparoscopic rectal surgery has not yet been satisfactorily clarified.In this paper we have focused on circumferential margin assessment and the quality of the mesorectal excision,comparing laparoscopic and open resection for cancer of the middle and lower rectum.The results of surgical procedures for middle and low rectal cancer were analysed.All the interventions were performed at the Department of Surgery,Teaching Hospital in Hradec Kralove,during the period from Jan 2011 to Dec 2012.The data were prospectively collected and entered in the Rectal Cancer Registry. Age, gender,BMI,tumour localisation and topography,the clinical stage, preoperative chemoradiotherapy and response to it,the type of surgery,distal and circumferential margin characteristics,mesorectal excision quality, pT and pN were compared for laparoscopic and open surgery.A total of 161 patients were operated on for rectal cancer during the abovementioned period.94 patients were included in the trial following selection.Laparoscopy was used in 40 patients and open surgery in 54 patients.Laparoscopic approach was performed in 33 low anterior resections,6 abdominoperineal amputations and 1 Hartmann’s procedure.Open surgery was used for 26 low anterior resections,21 APR and 7 Hartmann’s procedures.Complete mesorectal excision was achieved in 45% of the laparoscopic resections vs. 46.3% of open resections.Nearly complete excision was performed in 22.5% and 11.1%, respectively.Finally, incomplete excision was described in 30% X 38.9%.No available data for TME was detected in three patients.Positive circumferential margin was found in 5 patients in the laparoscopy group;on the contrary,in the group undergoing open surgery, pCRO+ was found in 15 patients.Particularly, mesorectal excision quality and negative CRM results have proven that the laparoscopic technique is safe and comparable to open surgery in rectal cancer treatment.