A Comparison of Laparoscopic and Open Technique in Patients with Low Anterior Resection due to Rectal Cancer

INTRODUCTION: Laparoscopic approach in rectal cancer surgery has been become the standard technic.In present study, it was aimed to compare the patients characteristics, postoperative complications and pathological data of the group that underwent laparoscopic low anterior resection (LAR) and underwent LAR by laparotomy(open) due to rectum cancer.
METHODS: In present study, between January 2012 and December 2015, laparoscopic or open LAR was performed by the same surgical team to 201 consecutive patients who diagnosed as rectal cancer. These patients’ gender, age, tumor location, early period complications and pathological datas were evaluated retrospectively.
RESULTS: A total of 201 patients who underwent LAR with 93 (46.6%) laparoscopic and 108 (53.4%).Open surgical techniques were included in the study.There was no mortality in the early postoperative period in either group. Postoperative morbidity (infection, ileus-subileus, anastomotic leakage, stoma complications) was detected in 12 (12.9%) patients in the laparoscopy group and 21 (19.4%) in the open surgery group (p> 0.05).The mean number of dissected lymph nodes in both groups was similar (13.04 ± 7.29 and 13.24 ± 6.58) (p = 0.525). When the distal resection margin (DRM) was compared, the laparoscopic surgery group was found to have a statistically significant farther DRM distance (3.81 ± 1.82 cm vs 3.04 ± 1.81 cm), (p <0.001).The circumferential resection margin (CRM), was more distant in the laparoscopic surgery group (1.89 ± 1.01 cm and 1.45 ± 0.79 cm, p <0.001). DRM and CRM positivity was not detected in anycase in either group.
DISCUSSION AND CONCLUSION: When laparoscopic rectum cancer surgery is performed in high-volume institutions and by experienced surgeons, it is seen that it provides an advantage in terms of early clinical results and oncological data compared to open rectal surgery, especially in terms of DRM and CRM width.

Rektum Kanseri Nedeniyle Aþaðý Anterior Rezeksiyon Yapýlan Hastalarda Laparoskopik ve Açýk Tekniðin Karþýlaþtýrýlmasý

GÝRÝÞ ve AMAÇ: Rektum kanseri cerrahisinde laparoskopik yaklaþým standart olmaya baþlamýþtýr. Bu çalýþmada rektum kanseri nedeniyle laparoskopik aþaðý anterior rezeksiyon yapýlan grup ile laparotomi ile aþaðý anterior rezeksiyon(AAR) yapýlan grubun erken dönem hasta özellikleri, postoperatif komplikasyonlar ve patolojik verilerinin karþýlaþtýrýlmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Çalýþmamýzda Ocak 2012 ile Aralýk 2015 tarihleri arasýnda rektum kanseri tanýsý ile ayný cerrahi ekip tarafýndan laparoskopik veya açýk AAR uygulanan ardýþýk 201 hastanýn; cinsiyet, yaþ, tümör yerleþimi, erken dönem komplikasyonlarý ve patolojik verileri retrospektif olarak deðerlendirilmiþtir.
BULGULAR: Çalýþmaya 93 (%46,6) laparoskopik, 108(%53,4) açýk cerrahi teknik ile AAR uygulanan toplam 201 hasta dahil edilmiþtir. Her iki grupta da ameliyat sonrasý erken dönemde mortalite görülmemiþtir. Post operatif morbidite (enfeksiyon, ileus-subileus, anastomoz kaçaðý, stoma komplikasyonlarý) laparoskopi grubunda 12 (%12,9) hastada, açýk cerrahi grubunda 21 (%19,4) saptanmýþtýr(p>0,05). Her iki grupta diseke edilen ortalama lenf nodu sayýsý benzer bulunmuþtur (13.04±7.29 ve 13.24±6.58) (p=0,525). Distal cerrahi sýnýr (DCS) karþýlaþtýrýlýdýðýnda laparoskopik cerrahi grubunun daha uzak DCS mesafesi olduðu bulunmuþtur (3.81±1.82 cm ve 3.04±1.81cm, p<0,001). Radyal cerrahi sýnýr (RCS) laparoskopik cerrahi grubunda daha uzak bulunmuþtur(1.89±1.01 cm ve 1.45±0.79 cm, p<0,001). DCS ve RCS pozitifliði laparoskopik ve açýk cerrahi grubunda hiçbir olguda saptanmamýþtýr.
TARTIÞMA ve SONUÇ: Laparoskopik rektum kanseri cerrahisi yüksek hacimli kurumlarda ve deneyimli cerrahlar tarafýndan gerçekleþtirildiðinde erken dönem klinik sonuçlar ve onkolojik veriler açýsýndan açýk rektum cerrahisine göre özellikle DCS ve RCS ‘ýn geniþliði olarak avantaj saðladýðý görülmektedir.