INTRODUCTION: The laparoscopic technique is widely adopted in the surgical treatment of colorectal carcinoma. Thus, patients benefit from the usual short-term advantages of minimally invasive surgery over classical open surgery, with comparable long-term oncological results.
AIM: The study presents the experience of the Clinic for General and Endoscopic Surgery of St. Ivan Rilski University Hospital in Sofia, with laparoscopic radical rectal resections for rectal carcinoma over a 14-year period and more than 450 completed laparoscopic interventions.
MATERIALS AND METHODS: From January 2009 until December 2022, 454 laparoscopic curative rectal resections for rectal carcinoma were performed. Only patients with cT1–cT3 tumors, without distant metastases, were included in the study.
RESULTS: The studied group included 301 (66.3%) men and 153 (33.7%) women, aged between 34 and 86 years, with an average BMI of 26 kg/m2 (21–32 kg/m2). According to the localization of the tumor in the rectum, the patients were divided as follows: proximal 1/3 (10–15 cm)—148 (32.6%); middle 1/3 (5 < 10 cm)—203(44.7%), and distal 1/3(< 5 cm)—103 (22.7%). A total of 277 (61%) patients underwent neoadjuvant chemoradiation. Eighty-five (18.7%) of the operated were in the 1st stage, 159 (35%)—in the 2nd stage, 219 (46.3%)—in the 3rd stage. Conversion was necessary in 23 cases (5.1%). The average duration of the operative intervention was 180 minutes. (120–420 min), and the blood loss was 80 mL (20–800 mL). Intestinal passage was restored on average on the 2nd postoperative day (1–7 days). The average postoperative hospital stay was 5 days (3–17 days). Complications occurred in 35 patients (7.7%). The operated patients were followed up for an average of 36 months (3–60). The overall recurrence rate was 15.6%.
CONCLUSION: Laparoscopic rectal resections for carcinoma are safe interventions, characterized by less postoperative pain, less blood loss, faster bowel recovery, shorter hospital stay, and excellent cosmetic results with comparable to open surgery oncological outcomes.
Griffen FD, Knight CD Sr, Whitaker JM, Knight CD Jr. The double stapling technique for low anterior resection. Results, modifications, and observations. Ann Surg. 1990;211(6):745-51; discussion 751-2. doi: 10.1097/00000658-199006000-00014.
Edge SB, Byrd DR, Compton CC, Fritz AG, Green FL, Trotti A, editors. AJCC cancer staging manual. 7th ed. New York: Springer; 2015.
Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery--the clue to pelvic recurrence? Br J Surg. 1982 Oct;69(10):613-6. doi: 10.1002/bjs.1800691019.
Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, et al. Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA. 2015;314(13):1346-55. doi: 10.1001/jama.2015.10529.
Stevenson AR, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Gebski VJ, et al. Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA. 2015;314(13):1356-63. doi: 10.1001/jama.2015.12009.
Stevenson ARL, Solomon MJ, Brown CSB, Lumley JW, Hewett P, Clouston AD, et al. Disease-free survival and local recurrence after laparoscopic-assisted resection or open resection for rectal cancer: the Australasian laparoscopic cancer of the rectum randomized clinical trial. Ann Surg. 2019;269(4):596-602. doi: 10.1097/SLA.0000000000003021.
Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol. 2007;25(21):3061-8. doi: 10.1200/JCO.2006.09.7758.
van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14(3):210-8. doi: 10.1016/S1470-2045(13)70016-0.
Aziz O, Constantinides V, Tekkis PP, Athanasiou T, Purkayastha S, Paraskeva P, Darzi AW, Heriot AG. Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol. 2006;13(3):413-24. doi: 10.1245/ASO.2006.05.045.
Ohtani H, Tamamori Y, Azuma T, Mori Y, Nishiguchi Y, Maeda K, et al. A meta-analysis of the short- and long-term results of randomized controlled trials that compared laparoscopy-assisted and conventional open surgery for rectal cancer. J Gastrointest Surg. 2011;15(8):1375-85. doi: 10.1007/s11605-011-1547-1
Deijen CL, Velthuis S, Tsai A, Mavroveli S, de Lange-de Klerk ES, Sietses C, et al. COLOR III: a multicentre randomised clinical trial comparing transanal TME versus laparoscopic TME for mid and low rectal cancer. Surg Endosc. 2016;30(8):3210-5. doi: 10.1007/s00464-015-4615-x.
Jiang WZ, Xu JM, Xing JD, Qiu HZ, Wang ZQ, Kang L, et al. Short-term outcomes of laparoscopy-assisted vs open surgery for patients with low rectal cancer: the LASRE randomized clinical trial. JAMA Oncol. 2022;8(11):1607–15. doi: 10.1001/jamaoncol.2022.4079.
Feng Q, Yuan W, Li T, Tang B, Jia B, Zhou Y, et al. Robotic versus laparoscopic surgery for middle and low rectal cancer (REAL): short-term outcomes of a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol. 2022;7(11):991-1004. doi: 10.1016/S2468-1253(22)00248-5
Email this article (Login required) 
