Dr. Ranbir Singh, MS, FMUHS, MIS1, Shailesh Puntambekar2. 1Galaxy Care Laparoscopic Institute, Pune, India, 2Galaxy care Laparoscopic Institute
Introduction: The role of minimal invasive surgery is well established. As regards rectal cancers particularly low lying rectal cancer studies are still going on for safety, feasibility and duplicability. A large prospective single institutional study aims to assess the effectiveness of our technique of Laparoscopic resection of rectal cancer in terms of oncological safety, complications and long term prognosis.
Method: Between July 2006 to June 2016, 582 patients underwent laparoscopic LAR for rectal adenocarcinoma at our Minimal Invasive Oncology Centre. Routine preoperative work up was done. Patients were evaluated for complications and were graded and managed as per Clavien-Dindo classification. Survival probability analysis rate using Kaplan Meier method.
Results: Total number of Patient included in the study was 582(375 men and 207 women) average age of 65 years. Tumour located in upper, middle and lower rectum were 132, 258 and 192 patients respectively. A total of 33 patients received chemoradiation preoperatively and 450 patients received chemotherapy/Radiation and chemoradiation postoperatively. Laparoscopic TME was done in 381 patients. 6 out of 381patients underwent low anterior resection with hand sewn coloanal anastomosis (CAA).
Average operating time was 124 minutes with an average of 70 ml blood loss and an average of 5 days as hospital stay. Average number of Lymph nodes removed were 25.4
The overall complication rate was 20.8% i.e. 121out of 582 patients had complications graded under Clavien-Dindo classification. No conversion to conventional surgery was required. The most common postoperative complication was the anastomotic leak. (Grade II, IIIB and IV acc. to Clavien- Dindo classification) we had 71 leaks (13.4%).After a mean follow up of 46 months (1-128 months),tumor recurrence occurred in 39 patients of 582. Overall recurrence rate was 6.7%.Overall Cancer related survival rate was 99.3%, 96.7%, and 90.7%, 90.7% and 87.7% at1st, and 2nd, 3rd, 4th and 5th year respectively. Five year survival rate was 100% for stage I, 94.4% for stage II, 66.6% for stage III, and 44.6% for stage IV.
Conclusion: Laparoscopic TME technique is feasible and safe. With development of improved technique, devices and expertise, laparoscopic resection for rectal cancer should be a standard method. Our results clearly demonstrate that laparoscopic rectal resection is not associated with higher morbidity or mortality. Furthermore oncological and surgical principles were respected and long term outcomes compared to the previous literature and open surgery were comparable.
Single largest Series of Laparoscopic management of Rectal cancer from India.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87368
Program Number: P265
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster