Single center comparative study of oncologic outcome in laparoscopic versus open rectal cancer surgery

Amir Taheri, MD, Erica Haase, MD, Cliff Sample, MD. University of Alberta

Background: Colorectal adenocarcinoma is the third most common site for new cancers and death in both men and women. The unique anatomy of the rectum, with its retroperitoneal location in a narrow pelvis and proximity to the urogenital organs, autonomic nerves, and anal sphincters, makes surgical access relatively difficult. Prognosis in rectal cancer including the mortality, recurrence and disease free survival is tightly related to adequacy of TME, number of lymph nodes harvested and margin status. In recent years, laparoscopy has gained worldwide interest as a method of rectal cancer surgery. Several prospective randomized control trials has compared laparoscopic versus open technique for TME resection, showing the advantages of laparoscopic surgery in terms of a shorter hospital stay, decreased post-op ileus while having equivalent survival and recurrence rate. In this study, we will compare oncologic outcome of open versus laparoscopic rectal cancer surgery in a high volume center.

Hypothesis: Laparoscopic TME resection for rectal cancer is oncologically safe and there is no difference in TME adequacy, margin status and number of harvested lymph nodes.

Methods: All adult patients with rectal cancer who had electiveTME resection from 2005-2013 at Grey Nuns hospital, Edmonton, with no evidence of locally advanced or metastatic disease pre or intra-operatively, were identified and reviewed. Oncologic outcome including TME adequacy, margin status and harvested Lymph node numbers were compared using chi square and exact fisher test.

Results: 159 patients with TME resection were included in our study and their pathologic results were reviewed. 119 patients (%74) had open and 40 (%26) had laparoscopic TME resection. Only one patient in open group had inadequate TME resection with no statistically significant difference between both groups (P value: 0.55). There were 3 patients (%2.7) with positive distal margin in open group who had re excision and none in laparoscopic group. There was no positive CRM in both groups. No significant difference between two groups were detected (P value: 0.57). Average number of 18.3 lymph nodes in open and 17.7 in laparoscopic group were harvested and no statistically significant difference was observed between the two groups (P value: 0.45).

Discussion:TME resection can be used as a valuable tool for grading the surgeon and an excellent tool to audit the center. Laparoscopic TME resection should be done by an experienced team in a high volume center and is oncologically safe.

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