Comparison of short-term outcomes following open and laparoscopic resections for colorectal malignancies
Keywords:Colorectal malignancies, Lymph node yield, Open and laparoscopic resection, Short term outcomes
Background: The laparoscopic approach for colorectal cancers are still a matter of controversy. In the present study, we tried to compare the laparoscopy with open methods of colorectal resections.
Methods: Retrospective study where patients diagnosed with colorectal cancer in our hospital from year 2014 January to December 2016 were taken. Total number of cases were 69 of which, the total number of right colon cases were 26. Out of twenty-six, 12 underwent open procedure and 14 underwent laparoscopic resections. Total number of left colon cancers were 09. Of these, 2 underwent open and 7 underwent laparoscopic procedure. Thirty-four (34) rectal cancers were included in the study. Of these, 12 underwent open rectal procedures and 22 underwent laparoscopic resections. Multiple parameters like duration of surgery, post-operative complications, postoperative stay, pathological T staging, lymph node yield, positive nodes, distal resection margins, circumferential radial margins were compared.
Results: Operating time was significantly shorter in open procedure than laparoscopic surgery in both rectal resection and right hemicolectomies. The postoperative stay was significantly shorter in laparoscopic right hemicolectomy compared to open procedure. All other parameters like post-operative complications, T stage, lymph node yield, positive nodes, distal resection margins and CRMs were comparable in both groups. The lymph node yield was similar in upfront and post neoadjuvant carcinoma rectum cases.
Conclusions: Laparoscopic colorectal resections have similar rates of complication, with shorter hospital stays with no compromise on oncological clearance with respect to lymph node yield, CRMs, distal resection margins compared to open procedures.
Schwenk W, Haase O, Neudecker J, Müller JM. Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev. 2005;3:CD003145.
McFarlane JK. Mesorectal excision for rectal cancer. Lancet. 1993;341:457-60.
Boutros M. Laparoscopic resection of rectal cancer results in higher lymph node yield and better short-term outcomes than open surgery: a large single- center comparative study. Dis Colon Rectum. 2013;56:679-88.
Khan JS. Clinical outcome of laparoscopic and open colectomy for right colonic carcinoma. Ann R Coll Surg Engl. 2011;93:603-07.
El-Gazzaz Galal. Does a laparoscopic approach affect the number of lymph nodes harvested during curative surgery for colorectal cancer? Surg Endosc. (2010);24:113-8.
Heidi Nelson, Guidelines 2000 for Colon and Rectal Cancer Surgery. J National Cancer Inst. 2001;93(8).
Lujan. Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg. 2009;96:982-9.
Bonjer HJ. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med. 2015;372:1324-32.
Xiong B. Laparoscopic versus open total mesorectal excision for middle and low rectal cancer: a meta-analysis of results of randomized controlled trials. J Laparoendoscopic Advanced Surgical Tech. 2012;22(7).
Morcos B. Lymph node yield in rectal cancer surgery: effect of preoperative chemoradiotherapy. EJSO. 2010;36(4):345-9.
Elsheikh S. Factors inuence lymph node retrieval after resection for rectal cancer. J Adenocarcinoma. 2016;1:2.
Zheng H. Laparoscopic versus open right hemicolectomy with curative intent for colon carcinoma. World J Gastroenterol. 2005;11(3):323-6.
Nelson H, Sargent DJ, Wieand HS, Fleshman J, Anvari M, Stryker SJ, et al. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350:2050-9.