Laparoskopische Operationen bei Rektumkarzinomen

Purpose

A number of minimally invasive techniques have now been described for rectal cancer resection. However, current outcome data for these approaches from high-volume single institutions remain limited. Our aim was to review outcomes in patients currently undergoing minimally invasive surgery for rectal cancer at our institution.

Methods

A retrospective analysis was performed to assess short-term benefits and oncologic outcomes in patients undergoing minimally invasive surgery for rectal cancer between 2004 and 2007.

Results

A total of 100 consecutive patients (61 men, median age 62) with a median follow-up of 1.8?years were identified. Of these, 67 underwent hand-assisted laparoscopic surgery (HALS) and 33 laparoscopic-assisted (LA) procedures. In all, 72 patients underwent anterior resection, 27 abdominal perineal resection, and one total proctocolectomy. Tumor stages were stage 1 (21%), stage 2 (17%), stage 3 (56%), and stage 4 (6%). A median of 16 lymph nodes were removed, while both a median distal margin of 3.4?cm and a 99% negative circumferential margin were achieved. The 3-year disease-free and overall survival rates were 86.2 and 94.5%, respectively. Three cases required conversion. Median time to both food intake and first bowel movement was 3?days, while the median length of stay was 5?days. Length of stay, time to soft diet, incision length, and pain scores were less using an LA approach compared to HALS (P<0.01). Overall morbidity was 26% with no mortality.

Conclusions

Both minimally invasive techniques used achieved excellent oncologic results in patients with rectal cancer. The LA approach had slightly better short-term outcomes.