Minimally Invasive Surgery of Rectal Cancer: Current Evidence and Options

2012 ◽  
pp. 214-218 ◽  
Author(s):  
Atthaphorn Trakarnsanga ◽  
Martin R. Weiser
Keyword(s):  
Rectal Cancer ◽  
Colon Cancer ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Oncologic Outcomes ◽  
Current Status ◽  
Current Evidence ◽  
Short Term ◽  
Invasive Approach

Overview: Minimally invasive surgery (MIS) of colorectal cancer has become more popular in the past two decades. Laparoscopic colectomy has been accepted as an alternative standard approach in colon cancer, with comparable oncologic outcomes and several better short-term outcomes compared to open surgery. Unlike the treatment for colon cancer, however, the minimally invasive approach in rectal cancer has not been established. In this article, we summarize the current status of MIS for rectal cancer and explore the various technical options.

scholarly journals Minimally Invasive Surgery in Pediatric Surgical Oncology

Children ◽  
2018 ◽  
Vol 5 (12) ◽  
pp. 158 ◽  
Author(s):  
Hannah Phelps ◽  
Harold Lovvorn, III
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Surgical Site Infections ◽  
Surgical Oncology ◽  
Current Evidence ◽  
Invasive Approach ◽  
Treatment Regimens ◽  
Pediatric Solid Tumors ◽  
Oncologic Resection

The application of minimally invasive surgery (MIS) to resect pediatric solid tumors offers the potential for reduced postoperative morbidity with smaller wounds, less pain, fewer surgical site infections, decreased blood loss, shorter hospital stays, and less disruption to treatment regimens. However, significant controversy surrounds the question of whether a high-fidelity oncologic resection of childhood cancers can be achieved through MIS. This review outlines the diverse applications of MIS to treat pediatric malignancies, up to and including definitive resection. This work further summarizes the current evidence supporting the efficacy of MIS to accomplish a definitive, oncologic resection as well as appropriate patient selection criteria for the minimally invasive approach.

The Impact of Conversion to Laparotomy in Rectal Cancer

2020 ◽  
Vol 86 (7) ◽  
pp. 811-818
Author(s):  
Salvatore A. Parascandola ◽  
Salini Hota ◽  
Mayou Martin T. Tampo ◽  
Andrew D. Sparks ◽  
Vincent Obias
Keyword(s):  
Rectal Cancer ◽  
Minimally Invasive ◽  
Large Population ◽  
Oncologic Outcomes ◽  
Minimally Invasive Approach ◽  
Short Term ◽  
Population Database ◽  
Invasive Approach ◽  
Positive Margins ◽  
The Impact

Background Data regarding the effect of conversion from minimally invasive surgery (MIS) to laparotomy in rectal cancer is limited. This study examines the impact of conversion from laparoscopic or robotic-assisted techniques to open resection on oncologic outcomes in a large population database. Methods The National Cancer Database from 2010 to 2016 was reviewed for all cases of invasive adenocarcinoma of the rectum or rectosigmoid junction managed surgically. Patients were divided into 3 cohorts by approach: laparoscopic/robotic (MIS), converted proctectomy (CP), and open proctectomy (OP). Kaplan–Meier estimation was used for unadjusted survival analysis, followed by adjusted multivariable Cox-Proportional Hazards regression. Secondary outcomes were analyzed by multivariable logistic regression. Results The inclusion criteria identified 57 574 patients cases of adenocarcinoma of the rectum managed surgically. Of these patients, 23 579 (41.0%) underwent MIS, 3591 (6.2%) CP, and 30 404 (52.8%) OP. Five-year overall survival was greater in the MIS (70.4%) versus CP and OP (64.4% and 61.4%). No differences were detected for positive margins, 30-day, or 90-day mortality between CP and OP. MIS and CP approaches were significantly associated with increased odds of 12 or more regional lymph nodes examined and decreased overall mortality hazard compared with OP (all respective significant P < .05). Discussion While similar odds of positive margins and short-term mortality is seen in patients whose procedure converts to laparotomy compared with planned laparotomy, both short-term and long-term oncologic benefit is seen in those who undergo a minimally invasive approach. Thus, a minimally invasive approach should be attempted for patients with rectal cancer.

Minimally Invasive Surgery Results in Improved Short-term Outcomes and Better Lymphadnectomy for Distal Rectal Cancer

2011 ◽  
Vol 165 (2) ◽  
pp. 300
Author(s):  
C.L. Marshall ◽  
S.T. Orcutt ◽  
C.J. Balentine ◽  
C.N. Robinson ◽  
A. Artinyan ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Short Term ◽  
Distal Rectal Cancer

scholarly journals The minimally invasive approach, laparoscopic and robotic, in rectal resection for cancer: A single center experience

2010 ◽  
Vol 57 (3) ◽  
pp. 29-35 ◽  
Author(s):  
I. Popescu ◽  
C. Vasilescu ◽  
V. Tomulescu ◽  
S. Vasile ◽  
O. Sgarbura
Keyword(s):  
Rectal Cancer ◽  
Minimally Invasive Surgery ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Metastatic Lymph Node ◽  
Robotic Approach ◽  
Invasive Approach ◽  
Significant Difference

Background: Robotic approach for rectal cancer competes with laparoscopy in centers dedicated to minimally invasive surgery (MIS) due to the technologic advantage. This is a report of our experience with MIS for rectal cancer. Methods: A series of 84 consecutive patients with laparoscopic resection (between 1995-2010) and 38 consecutive patients with robotic resection (between 2008-2010) for primary rectal cancer were analyzed. Hartmann's procedures were excluded. Clinical and pathologic outcomes were reviewed retrospectively. Results: In the laparoscopic group (LG), 50 anterior rectal resections (ARR), 34 abdominal perineal resections (APR) were performed while in the robotic group(RG) there were 30 ARR and 8 APR. The median operative time was 182 min (140-220 min) in LG and 208 min (180- 300 min) in RG (p=0.0002). No statistically significant difference was noticed between the groups in terms of conversion, morbidity, anastomotic leak and postoperative stay rates. Margin clearance was obtained in all patients and the median number of removed lymph nodes was similar: 11.37 in RG vs 11.07 in the LG (p=0.65) with a higher rate of metastatic lymph node involvement in laparoscopy (p=0.0012). Blood loss was higher in LG (150 ml vs. 100 ml; p=0.0001). There were 5 (5.9%) local recurrences in the LG at a median follow- up of 27.5 months and 2 (5.2%) in the RG at a median follow-up of 13 months (p=0.43). Conclusions: Minimally invasive surgery for rectal cancer proved to be safe and efficient with similar results in the two groups. Technological advances of robotic approach compared to laparoscopy allowed better ergonomics, more refined dissection, easier preserving of hypogastric nerves and less blood loss. Long term outcomes are to be assessed in prospective randomized studies.

scholarly journals Complete mesocolic excision in minimally invasive surgery of colonic cancer: do we need the robot?

2020 ◽  
Author(s):  
Dirk Wilhelm ◽  
Thomas Vogel ◽  
Philipp-Alexander Neumann ◽  
Helmut Friess ◽  
Michael Kranzfelder
Keyword(s):  
Colon Cancer ◽  
Minimally Invasive Surgery ◽  
Robotic Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Complete Mesocolic Excision ◽  
Current Evidence ◽  
Lymph Node Yield ◽  
Conversion Rates ◽  
Mesocolic Excision

Summary Background Robotic surgery offers favorable prerequisites for complex minimally invasive surgeries which are delivered by higher degrees of freedom, improved instrument stability, and a perfect visualization in 3D which is fully surgeon controlled. In this article we aim to assess its impact on complete mesocolic excision (CME) in colon cancer and to answer the question of whether the current evidence expresses a need for robotic surgery for this indication. Methods Retrospective analysis and review of the current literature on complete mesocolic excision for colon cancer comparing the outcome after open, laparoscopic, and robotic approaches. Results Complete mesocolic excision results in improved disease-free survival and reduced local recurrence, but turns out to be complex and prone to complications. Introduced in open surgery, the transfer to minimally invasive surgery resulted in comparable results, however, with high conversion rates. In comparison, robotic surgery shows a reduced conversion rate and a tendency toward higher lymph node yield. Data, however, are insufficient and no high-quality studies have been published to date. Almost no oncologic follow-up data are available in the literature. Conclusion The current data do not allow for a reliable conclusion on the need of robotic surgery for CME, but show results which hypothesize an equivalence if not superiority to laparoscopy. Due to recently published technical improvements for robotic CME and supplementary features of this method, we suppose that this approach will gain in importance in the future.

scholarly journals Atvirųjų ir laparoskopinių kolorektalinių onkologinių operacijų palyginimas

2008 ◽  
Vol 6 (4) ◽  
pp. 0-0
Author(s):  
Giedrė Rudinskaitė ◽  
Narimantas Evaldas Samalavičius ◽  
Renatas Tikuišis
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Laparoscopic Resection ◽  
Cancer Surgery ◽  
Colorectal Cancer Surgery ◽  
Duration Of Surgery

Giedrė Rudinskaitė1, Narimantas Evaldas Samalavičius2, Renatas Tikuišis31, 2 Vilniaus universiteto Onkologijos instituto Abdominalinės ir bendrosios chirurgijosir onkologijos skyrius, Santariškių g. 1, LT-08660 Vilnius3 Vilniaus universiteto Onkologijos instituto Intensyviosios terapijos ir anesteziologijos skyrius,Santariškių g. 1, LT-08660 VilniusEl paštas: [email protected] Nors minimaliai invaziniu būdu operuojama daugelis neonkologinių ligų, laparoskopinės kolorektalinio vėžio chirurgijos pripažinimas yra daug mažesnis. Priežastis buvo tokie veiksniai kaip operacijos technikos sudėtingumas, kaina, operacijos trukmė, ilga mokymosi kreivė ir rūpestis onkologiniu saugumu. Chirurgų bendruomenei užtruko daugiau nei dešimt metų įteisinti laparoskopinį kolorektalinio vėžio gydymo metodą: jis yra saugus, pacientams užtikrina visus laparoskopinės chirurgijos pranašumus. Duomenys taip pat parodė, kad išgyvenamumas po laparoskopinės ir laparotominės gaubtinės žarnos vėžio rezekcijos nesiskiria. Tyrimai, nagrinėjantys išgyvenamumą po tiesiosios žarnos vėžio laparoskopinės rezekcijos, buvo pradėti vėliau ir 5 metų išgyvenamumo rezultatai dar negauti. Šioje apžvalgoje pateikiami iki šiol gauti ir metaanalizės būdu išnagrinėti kolorektalinio vėžio laparoskopinių operacijų rezultatai Reikšminiai žodžiai: gaubtinės žarnos vėžys, tiesiosios žarnos vėžys, laparoskopinė rezekcija A comparison of laparoscopic and open colorectal cancer surgery Giedrė Rudinskaitė1, Narimantas Evaldas Samalavičius2, Renatas Tikuišis31, 2 Abdominal and General Surgical Oncology Department, Institute of Oncology,University of Vilnius, Santariškiu str. 1, LT-08660 Vilnius, Lithuania3 Intensive Care and Anestesiology Department, Institute of Oncology, University of Vilnius,Santariškių str. 1, LT-08660 Vilnius, LithuaniaE-mail: [email protected] Although minimally invasive surgery has been accepted for a variety of disorders, laparoscopic resection of colorectal cancer surgery gained much less acceptance. The reasons were the factors such as technical complexity, cost, duration of surgery, the long learning curve and concerns about oncologic safety. It took the surgical community more than a decade to admit that the laparoscopic optikon for colorectal cancer is legitimate: it is safe, and it provides the patients with the advantages of minimally invasive surgery. Data indicate that there are no oncologic differences between laparoscopic and open resections for the treatment of primary colon cancer. Initiated later than for colon cancer, the 5-year survival evaluation of the use of laparoscopy in rectal cancer is still ongoing. This review presents recently published metaanalyses of colorectal cancer laparoscopic surgery. Keywords: cancer of colon, rectal cancer, laparoscopic resection

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