north manchester general hospital lap vs_open_mr_luparini

Francesco Luparini Colorectal Team - North Manchester General Hospital

Laparoscopic vs Laparotomic Resection for Rectal Cancer: Our Experience

• Aim: to evaluate the differences of oncological clearance in Laparoscopic vs. Open Resection for Rectal AdenoCa

Aim of the StudySingle Centre Study

Oncological Clearance

Lymph Node Retrieval Lesion from Cut End Circumferential

Resection Margin

Outline of the StudyPatients’ features

Laparoscopic OpenAge (m±DS) 67.8 ± 10.7 69.31 ± 12.35

M/F % 55% 59%

• Retrospective non-randomised study• Elective admissions for Anterior Resection in AdenoCa:

– 18 Laparoscopic vs. 42 Open• Period: Nov 2009 - Dec 2011 (25 months)

• Laparoscopic group: 2 cases of Complete Tumor Regression (CTR) to neoadjuvant therapy

Duke’s Stage Distribution in the two groups

LAP

CTRTisABC

OPEN

LAP OPEN0

5

10

15

20

25

30

35

40

45

No invasionVenous Invasion

27%33%

Venous InvasionSpreading of AdenoCa through vessels in two groups

ResultsLymph nodes retrieval

With regard to lymph nodes, no difference has been seen in two groups (p=NS)

Lymph nodes LAP OPEN

m ± DS 13.0 ± 5.3 15.7 ± 5.63

ResultsLesion from cut end (mm)

Distance from cut end LAP OPEN

m ± DS 56.4 ± 46.2 65.2 ± 64.9

range 15-200 0-300

With regard to distance of lesion from cut end, no difference has been seen in two groups (p=NS)

ResultsCircumferential Resection Margin (mm)

With regard to CRM, no difference has been seen in two groups (p=NS)

CRM (mm) LAP OPEN

m ± DS 12.69 ± 7.49 16.42 ± 19.54

range 0 - 25 0 - 70

R1 resection 1/18 2/42

• CT scan follow up (months): 8.5 ± 5.2

Follow-upResults

LAP OPENLocal Recurrence 1/18 2/42

Metastases 1 lung3 liver

1 lung3 liver

ConclusionsRetrospective non-randomised study

In our experience Laparoscopic Resection has proven to be as effective as Open Resection with regard to:• Lymph node retrieval• Distance from cut end• Circumferential Resection Margin

Further follow-up is needed to evaluate the Oncological Outcome