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Scripta Scientifica Medica

Laparoscopic or conventional abdominoperineal extirpation in low rectal cancer

Gancho Kostov, Rosen Dimov, Valentin Ivanov, Dimcho Argirov, Rangel Kunchev, Veselin Marinov, Dzhevdet Chakurov, Atanas Chapkunov, Maria Stoilova, Boris Boev

Abstract

INTRODUCTION: Laparoscopic abdominoperineal resection (LAPR) as a minimally invasive approach for the treatment of large rectal cancer is widely used. It has been proven to be technically feasible and safe with fewer complications and faster postoperative recovery than the open procedure. Our aim was to evaluate LAPR safety and feasibility as compared to the open procedure in large low rectal cancer.

PATIENTS AND METHODS: A total of 34 low rectal cancer patients who underwent open APR (OAPR) were matched with 42 patients who underwent LAPR in a one-to-one fashion between 2011 and 2014 in the Divi­sion of General Surgery, Kaspela University Hospital of Plovdiv.

RESULTS: Intraoperative parameters of LAPR were better than those of OAPR as followed: mean operation time (121.8±47.8 min versus 152.1±49.2 min), mean operative blood loss (82±30.0 mL versus 120±35.0 mL), mean total number of retrieved lymph nodes (12±1 versus 12±1.4), and percentage of surgical complications (12.3% versus 15.1%). Laparoscopically treated patients showed significantly shorter postoperative analge­sia (2.1±0.7 days versus 3.7±0.6 days), earlier first flatus (36.3±7.9 hours versus 48.5±9.2 hours), shorter uri­nary drainage (3.8±3.4 days versus 5.8±1.3 days), and shorter hospital stay (6.2±1 days versus 8±2.0 days). Local recurrence rate during a three-year period (in 3 versus 4 patients) and metachronous liver metastasis (in 5 versus 6 patients) were less common after LAPR than after OAPR.

CONCLUSION: The risks of APR-specific surgical complications such as perineal wound infection and para­stomal hernia were comparable between the laparoscopic and open surgery groups. There were no signifi­cant differences regarding local recurrence and metachronous liver metastasis between these groups. Com­plication and locoregional recurrence rates in low large rectal cancer patients after laparoscopic and open were quite similar. Scr Sci Med 2017; 49(3): 22-26


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DOI: http://dx.doi.org/10.14748/ssm.v49i3.4048

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About The Authors

Gancho Kostov
Medical University of Plovdiv

Department of Special Surgery, Faculty of Medicine

Rosen Dimov
Medical University of Plovdiv

Department of Special Surgery, Faculty of Medicine

Valentin Ivanov
Department of Surgery

Kaspela University Hospital of Plovdiv

Dimcho Argirov
Medical University of Plovdiv

Department of Special Surgery, Faculty of Medicine

Rangel Kunchev
Department of Surgery

Kaspela University Hospital of Plovdiv

Veselin Marinov
Faculty of Medicine

Department of Propedeutics of Surgical Diseases

Dzhevdet Chakurov
Faculty of Medicine

Department of Propedeutics of Surgical Diseases

Atanas Chapkunov
Faculty of Medicine

Department of Propedeutics of Surgical Diseases

Maria Stoilova
Medical University of Plovdiv

Department of Special Surgery, Faculty of Medicine

Boris Boev
Kaspela University Hospital of Plovdiv

Department of Surgery

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