Laparoscopic Versus Open Total Mesorectal Excision in Treatment of Middle-Low Rectal Cancer：A Clinical Comparative Study_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHU Jun , DING Jianhua , TANG Haiyan , ZHANG Bin , ZHAO Yong , TONG Jing , ZHAO Ke

Department of Colorectal Surgery， The Gerneral Hospital of the Second Artillery of PLA， Center of Anorectal Disease of PLA， Beijing 100088， China;

Corresponding?author：

Keywords：

Rectal neoplasm; Laparoscopy; Total mesorectal excision

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective 　To evaluate the feasibility, safety, radicality, and short-term and mid-term clinical outcomes of laparoscopic total mesorectal excision （TME） in comparison with open procedure for the middle-lower rectal cancer.
Methods 　From October 2005 to October 2008， 52 patients with middle-lower rectal cancer received laparoscopic TME （Dixon’operation） without preventive stoma， while 46 patients underwent conventional open TME （Dixon’operation） without preventive stoma. The operative procedures, clinicopathological data， and short-term and mid-term outcomes were collected and compared between the two groups.
Results 　The other patients were successful in both groups in addition to 2 （3.8%） patients were converted to open procedure in laparoscopic TME group. There was no perioperative death in both groups. The intraoperative blood loss, the time for bowel movement retrieval （first flatus）， and the incision healing in laparoscopic TME group were better than that in open TME group （P＜0.05）. No significant differences were observed between two groups in anastomotic leakage and pulmonary infection （P＞0.05）. Comparison of specimen, no significant differences were observed between two groups in negative distal margin and circumferential resection margin, number of lymph nodes resected, distance of distal resection margin to the tumor （P＞0.05）. No significant differences were observed between two groups in cancer-related death, local recurrence, distant metastasis, and 3-year survival rate （P＞0.05）.
Conclusions 　Laparoscopic TME for middle-low rectal cancer is a safe, feasible, and minimally invasive technique, and can achieve satisfactory oncological outcome, which provides similar short-term and mid-term outcome compared with the traditional open procedure.

Citation： ZHU Jun,DING Jianhua,TANG Haiyan,ZHANG Bin,ZHAO Yong,TONG Jing,ZHAO Ke,.. Laparoscopic Versus Open Total Mesorectal Excision in Treatment of Middle-Low Rectal Cancer：A Clinical Comparative Study. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(6): 636-641. doi: Copy

1.	鄭民華. 腹腔鏡結直腸癌手術的應用現狀與展望 [J]. 中華消化外科雜志， 2008， 7(3)：164-166.
2.	陸培華，陶圜清，沈偉，等. 國內腹腔鏡結直腸切除術根治效果的Meta 分析 [J]. 中華消化外科雜志， 2008， 7(6)：458-460.
3.	顧晉，杜長征. 從解剖學角度談中低位直腸癌術式選擇 [J].中國實用外科雜志， 2009， 29(4)：300-302.
4.	Ng SS， Leung KL， Lee JF， et al. Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer：a prospective randomized trial [J]. Ann Surg Oncol， 2008， 15(9)：2418-2425.
5.	Romano G， Gagliardi G， Bianco F， et al. Laparoscopic colorectal surgery：why it is still not the gold standard and why it should be [J]. Tech Coloproctol， 2008， 12(2)：185-188.
6.	Rosin D， Lebedyev A， Urban D， et al. Laparoscopic resection of rectal cancer [J]. Isr Med Assoc J， 2011， 13(8)：459-462.
7.	Pikarsky AJ， Rosenthal R， Weiss EG， et al. Laparoscopic total mesorectal excision [J]. Surg Endosc， 2002， 16(4)：558-562.
8.	中國抗癌協會大腸癌專業委員會腹腔鏡外科學組，中華醫學會外科分會腹腔鏡與內鏡外科學組. 腹腔鏡結腸直腸癌根治性手術操作指南(2006 版) [J]. 外科理論與實踐， 2006，.
9.	中國抗癌協會大腸癌專業委員會. 中低位直腸癌外科治療規范( 草案) [J]. 中華胃腸外科雜志， 2005， 8(1)：88-90.
10.	Jamali FR， Soweid AM， Dimassi H， et al. Evaluating the degree of difficulty of laparoscopic colorectal surgery [J]. Arch Surg，2008， 143(8)：762-767.
11.	(5)：462-464.
12.	Koopmann MC， Heise CP. Laparoscopic and minimally invasive resection of malignant colorectal disease [J]. Surg Clin North Am， 2008， 88(5)：1047-1072.
13.	Buchanan GN， Malik A， Parvaiz A， et al. Laparoscopic resection for colorectal cancer [J]. Br J Surg， 2008， 95(7)：893-902.
14.	Laurent C， Leblanc F， Bretagnol F， et al. Long-term wound advantages of the laparoscopic approach in rectal cancer [J]. Br J Surg， 2008， 95(7)：903-908.
15.	黃石川，游志堅，梁子君，等. 腹腔鏡結直腸腫瘤手術18 例報道 [J]. 中國普外基礎與臨床雜志， 2008， 15(10)：722-725.
16.	鄭民華，李健文，陸愛國，等. 腹腔鏡結直腸手術的學習曲線 [J]. 外科理論與實踐， 2002， 7(3)：187-189.
17.	Ito M， Sugito M， Kobayashi A， et al. Influence of learning curve on short-term results after laparoscopic resection for rectal cancer [J]. Surg Endosc， 2009， 23(2)：403-408.
18.	池畔，林惠銘. 腹腔鏡結直腸癌根治術學習曲線 [J]. 中華胃腸外科雜志， 2004， 7(5)：372-374.
19.	Lange MM， Buunen M， van de Velde CJ， et al. Level of arterial ligation in rectal cancer surgery：low tie preferred over high tie. A review [J]. Dis Colon Rectum， 2008， 51(7)：1139-1145.
20.	Fazio S， Ciferri E， Giacchino P， et al. Cancer of the rectum：comparison of two different surgical approaches [J]. Chir Ital，2004， 56(1)：23-30.
21.	Sato K， Inomata M， Kakisako K， et al. Surgical technique influences bowel function after low anterior resection and sigmoidcolectomy [J]. Hepatogastroenterology， 2003， 50(53)：1381-1384.
22.	Washington MK， Berlin J， Branton P， et al. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum [J]. Arch Pathol Lab Med， 2009， 133(10)：1539-1551.
23.	Dent OF， Haboubi N， Chapuis PH， et al. Assessing the evidence for an association between circumferential tumour clearance and local recurrence after resection of rectal cancer [J]. Colorectal Dis， 2007， 9(2)：112-121.
24.	Glynne-Jones R， Mawdsley S， Novell JR. The clinical significance of the circumferential resection margin following preoperative pelvic chemo-radiotherapy in rectal cancer：why we need a common language [J]. Colorectal Dis， 2006， 8(9)：800-807.
25.	Nagtegaal ID， Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? [J]. J Clin Oncol， 2008， 26(2)：303-312.
26.	Anderson C， Uman G， Pigazzi A. Oncologic outcomes of laparoscopic surgery for rectal cancer：a systematic review and metaanalysis of the literature [J]. Eur J Surg Oncol， 2008， 34(10)：1135-1142.
27.	梁小波，侯生槐，李國棟，等. 腹腔鏡直腸癌手術的療效分析 [J]. 中華消化外科雜志， 2010， 9(6)：411-414.
28.	施小龍，池畔，林惠銘. 腹腔鏡結直腸癌根治術療效分析 [J].中華消化外科雜志， 2010， 9(3)：207-209.
29.	Mirza MS， Longman RJ， Farrokhyar F， et al. Long-term outcomes for laparoscopic versus open resection of nonmetastatic colorectal cancer [J]. J Laparoendosc Adv Surg Tech A， 2008，18(5)：679-685.
30.	Bretagnol F， Lelong B， Laurent C， et al. The oncological safety of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma [J]. Surg Endosc， 2005， 19(7)：892-896.
31.	Jingli C， Rong C， Rubai X. Influence of colorectal laparoscopic surgery on dissemination and seeding of tumor cells [J]. Surg Endosc， 2006， 20(11)：1759-1761.
32.	Miyajima N， Fukunaga M， Hasegawa H， et al. Results of a multicenter study of 1 057 cases of rectal cancer treated by laparoscopic surgery [J]. Surg Endosc， 2009， 23(1)：113-118.
33.	范瑩，吳碩東，于宏，等. 腹腔鏡結直腸癌根治術與同期開腹手術對比的單中心回顧性研究 [J]. 中國普外基礎與臨床雜志， 2009， 16(5)：384-388.
34.	Laurent C， Leblanc F， Wütrich P， et al. Laparoscopic versus open surgery for rectal cancer：long-term oncologic results [J]. Ann Surg， 2009， 250(1)：54-61.
35.	Huang MJ， Liang JL， Wang H， et al. Laparoscopic-assisted versus open surgery for rectal cancer：a meta-analysis of randomized controlled trials on oncologic adequacy of resection and long-term oncologic outcomes [J]. Int J Colorectal Dis， 2011， 26(4)：415-421.
36.	Liang Y， Li G， Chen P， et al. Laparoscopic versus open colorectal resection for cancer：a meta-analysis of results of randomized controlled trials on recurrence [J]. Eur J Surg Oncol， 2008，34(11)：1217-1224.

1. 鄭民華. 腹腔鏡結直腸癌手術的應用現狀與展望 [J]. 中華消化外科雜志， 2008， 7(3)：164-166.
2. 陸培華，陶圜清，沈偉，等. 國內腹腔鏡結直腸切除術根治效果的Meta 分析 [J]. 中華消化外科雜志， 2008， 7(6)：458-460.
3. 顧晉，杜長征. 從解剖學角度談中低位直腸癌術式選擇 [J].中國實用外科雜志， 2009， 29(4)：300-302.
4. Ng SS， Leung KL， Lee JF， et al. Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer：a prospective randomized trial [J]. Ann Surg Oncol， 2008， 15(9)：2418-2425.
5. Romano G， Gagliardi G， Bianco F， et al. Laparoscopic colorectal surgery：why it is still not the gold standard and why it should be [J]. Tech Coloproctol， 2008， 12(2)：185-188.
6. Rosin D， Lebedyev A， Urban D， et al. Laparoscopic resection of rectal cancer [J]. Isr Med Assoc J， 2011， 13(8)：459-462.
7. Pikarsky AJ， Rosenthal R， Weiss EG， et al. Laparoscopic total mesorectal excision [J]. Surg Endosc， 2002， 16(4)：558-562.
8. 中國抗癌協會大腸癌專業委員會腹腔鏡外科學組，中華醫學會外科分會腹腔鏡與內鏡外科學組. 腹腔鏡結腸直腸癌根治性手術操作指南(2006 版) [J]. 外科理論與實踐， 2006，.
9. 中國抗癌協會大腸癌專業委員會. 中低位直腸癌外科治療規范( 草案) [J]. 中華胃腸外科雜志， 2005， 8(1)：88-90.
10. Jamali FR， Soweid AM， Dimassi H， et al. Evaluating the degree of difficulty of laparoscopic colorectal surgery [J]. Arch Surg，2008， 143(8)：762-767.
11. (5)：462-464.
12. Koopmann MC， Heise CP. Laparoscopic and minimally invasive resection of malignant colorectal disease [J]. Surg Clin North Am， 2008， 88(5)：1047-1072.
13. Buchanan GN， Malik A， Parvaiz A， et al. Laparoscopic resection for colorectal cancer [J]. Br J Surg， 2008， 95(7)：893-902.
14. Laurent C， Leblanc F， Bretagnol F， et al. Long-term wound advantages of the laparoscopic approach in rectal cancer [J]. Br J Surg， 2008， 95(7)：903-908.
15. 黃石川，游志堅，梁子君，等. 腹腔鏡結直腸腫瘤手術18 例報道 [J]. 中國普外基礎與臨床雜志， 2008， 15(10)：722-725.
16. 鄭民華，李健文，陸愛國，等. 腹腔鏡結直腸手術的學習曲線 [J]. 外科理論與實踐， 2002， 7(3)：187-189.
17. Ito M， Sugito M， Kobayashi A， et al. Influence of learning curve on short-term results after laparoscopic resection for rectal cancer [J]. Surg Endosc， 2009， 23(2)：403-408.
18. 池畔，林惠銘. 腹腔鏡結直腸癌根治術學習曲線 [J]. 中華胃腸外科雜志， 2004， 7(5)：372-374.
19. Lange MM， Buunen M， van de Velde CJ， et al. Level of arterial ligation in rectal cancer surgery：low tie preferred over high tie. A review [J]. Dis Colon Rectum， 2008， 51(7)：1139-1145.
20. Fazio S， Ciferri E， Giacchino P， et al. Cancer of the rectum：comparison of two different surgical approaches [J]. Chir Ital，2004， 56(1)：23-30.
21. Sato K， Inomata M， Kakisako K， et al. Surgical technique influences bowel function after low anterior resection and sigmoidcolectomy [J]. Hepatogastroenterology， 2003， 50(53)：1381-1384.
22. Washington MK， Berlin J， Branton P， et al. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum [J]. Arch Pathol Lab Med， 2009， 133(10)：1539-1551.
23. Dent OF， Haboubi N， Chapuis PH， et al. Assessing the evidence for an association between circumferential tumour clearance and local recurrence after resection of rectal cancer [J]. Colorectal Dis， 2007， 9(2)：112-121.
24. Glynne-Jones R， Mawdsley S， Novell JR. The clinical significance of the circumferential resection margin following preoperative pelvic chemo-radiotherapy in rectal cancer：why we need a common language [J]. Colorectal Dis， 2006， 8(9)：800-807.
25. Nagtegaal ID， Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? [J]. J Clin Oncol， 2008， 26(2)：303-312.
26. Anderson C， Uman G， Pigazzi A. Oncologic outcomes of laparoscopic surgery for rectal cancer：a systematic review and metaanalysis of the literature [J]. Eur J Surg Oncol， 2008， 34(10)：1135-1142.
27. 梁小波，侯生槐，李國棟，等. 腹腔鏡直腸癌手術的療效分析 [J]. 中華消化外科雜志， 2010， 9(6)：411-414.
28. 施小龍，池畔，林惠銘. 腹腔鏡結直腸癌根治術療效分析 [J].中華消化外科雜志， 2010， 9(3)：207-209.
29. Mirza MS， Longman RJ， Farrokhyar F， et al. Long-term outcomes for laparoscopic versus open resection of nonmetastatic colorectal cancer [J]. J Laparoendosc Adv Surg Tech A， 2008，18(5)：679-685.
30. Bretagnol F， Lelong B， Laurent C， et al. The oncological safety of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma [J]. Surg Endosc， 2005， 19(7)：892-896.
31. Jingli C， Rong C， Rubai X. Influence of colorectal laparoscopic surgery on dissemination and seeding of tumor cells [J]. Surg Endosc， 2006， 20(11)：1759-1761.
32. Miyajima N， Fukunaga M， Hasegawa H， et al. Results of a multicenter study of 1 057 cases of rectal cancer treated by laparoscopic surgery [J]. Surg Endosc， 2009， 23(1)：113-118.
33. 范瑩，吳碩東，于宏，等. 腹腔鏡結直腸癌根治術與同期開腹手術對比的單中心回顧性研究 [J]. 中國普外基礎與臨床雜志， 2009， 16(5)：384-388.
34. Laurent C， Leblanc F， Wütrich P， et al. Laparoscopic versus open surgery for rectal cancer：long-term oncologic results [J]. Ann Surg， 2009， 250(1)：54-61.
35. Huang MJ， Liang JL， Wang H， et al. Laparoscopic-assisted versus open surgery for rectal cancer：a meta-analysis of randomized controlled trials on oncologic adequacy of resection and long-term oncologic outcomes [J]. Int J Colorectal Dis， 2011， 26(4)：415-421.
36. Liang Y， Li G， Chen P， et al. Laparoscopic versus open colorectal resection for cancer：a meta-analysis of results of randomized controlled trials on recurrence [J]. Eur J Surg Oncol， 2008，34(11)：1217-1224.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Laparoscopic Versus Open Total Mesorectal Excision in Treatment of Middle-Low Rectal Cancer：A Clinical Comparative Study

Abstract Full text Figures/Tables Video References Cited by

Format

Content