Comparison of Laparoscopic Versus Open Surgery for Carcinoma Rectum in a Tertiary Care Cancer Centre
Chandramohan K, Kothari Kiran C, George P S, Patel MH and Gurjer GC
World journal of Minimal Access Surgery 2012, 1:1
Introduction: Rectal cancer surgery is traditionally performed by an open as well as laparoscopic surgical approach. Open approaches require laparotomy. Developments in instrumentation and optics have allowed the use of minimally invasive approaches to rectal cancer, which had been traditionally managed by open operation. Minimally Invasive Surgery avoids laparotomy and results in quicker return to normal functions and less morbidity. In this prospective study, we compared the immediate surgical and oncologic outcomes of patients who have undergone minimally invasive surgery with those who have had open surgery.
Patients and Methods: Between November 2003 and March 2006, 27 patients with cancer of rectum were recruited. Seventeen of them underwent minimally invasive surgery (MAS) (62.96%) and 10 patients (58.82%) were treated using open surgery (OS). Both operations were done by the same team of surgeons. The groups were compared in terms of perioperative outcomes, morbidity, mortality and adequacy of oncologic excision.
Results: The average duration of MIS was 216 minutes, varying from 150 to 399 minutes which was more than that of OS (180 minutes; range 120 – 300). The average blood loss was 190ml (120-310ml) in MIS compared to 270.45 ml (100-350ml) in open group. Average duration of hospitalization was 11.35 (7-35) days in MIS group compared to 12.5 (5-24) days in open group. Six (35.29%) patients in MIS group had developed morbidity. Similarly four (40%) patients in open group had morbidity. In the MIS average of 12.06 nodes (4 to 17 nodes) were excised during surgery. Average numbers of involved nodes were 2.82 (0-5). In Open Group, an average of 11.20 nodes (8 to 13 nodes) was excised during surgery. Average numbers of involved nodes were 20 (0 and 2). Discussion: MIS is oncologically safe compared to open surgery. It has almost similar postoperative course, morbidity pattern and duration of hospital stay as open surgery. Increased duration of procedure compared to open surgery is a disadvantage of minimally invasive surgery, especially in the early part of learning curve