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Laparoscopic surgery for rectal cancer
Authors:Manish Chand  Jemma Bhoday  Gina Brown  Brendan Moran  Amjad Parvaiz
Affiliation:1.Royal Marsden Hospital, Specialist Registrar Surgery, Sutton SM2 5PT, UK;2.Croydon University Hospital, Croydon CR7 7YE, UK;3.Basingstoke and North Hampshire Hospital, National Lead for Rectal Cancer, Basingstoke, Hampshire RG24 9NA, UK;4.Queen Alexandra Hospital, Cosham, PO6 3LY, UK
Abstract:
Laparoscopic surgery for colonic cancer is a safe and established alternative to traditional open colectomy. The potential advantages of shorter length of stay, faster recovery and fewer operative complications are well documented. The last 5 years has seen an increase in the number of laparoscopic colorectal operations as more surgeons learn this technique. Short and medium term results have been encouraging with respect to oncological outcomes. However, laparoscopic surgery for rectal cancer remains a contentious issue. The increased complexity of operating within the confines of the pelvis and the greater risk of oncological compromise, have led to some surgeons urging caution. We present the challenges associated with laparoscopic rectal cancer surgery and explain that appropriate patient selection, surgical planning and laparoscopic experience are the key to successful outcomes.Laparoscopic surgery for cancer of the colon is a safe and well established technique in selected patients, when performed by trained and suitably experienced surgeons. Although several studies have documented the benefits of laparoscopic surgery compared with conventional open colectomy such as reduced blood loss, decreased hospital stay and less post-operative pain,1,2 it is the equivalent oncological outcomes which have led to acceptance of a minimal access approach. However, laparoscopic resection for rectal cancer (defined as carcinoma within 15 centimetres of the anal verge) has not been as thoroughly evaluated and remains controversial.3 The main concern is fear of oncological compromise and that tumour clearance, and lymph node yields, as markers of surgical success may not be comparable with those achieved at open surgery. There is also a perceived risk of technical compromise due to the inflexibility of the instruments used during laparoscopy. This paper aims to highlight the potential benefits and challenges associated with laparoscopic rectal cancer surgery.
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